Otolaryngology Coding Alert

Question: Our physician got called for an inpatient consultation for patient with epistaxis. The nasal hemorrhage was difficult to control. He stayed with the patient for 1.5 hours to make sure no further bleeding occurred. In his report, he listed 99253-25 and 30905-22. Can I charge an observation code for the 1.5 hours spent with the patient, or can I raise the consultation code to 99254 if we document time spent? Alabama Subscriber Answer: Look to the prolonged services add-on code for the E/M, +99356 (Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour [List separately in addition to code for inpatient Evaluation and Management service]) for doctors extra face time with the patient. The reference time for 99353 (Inpatient consultation for a new or established patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making [...]