Eli's Rehab Report

Question: One of our physiatrists evaluates a hospital patient on day one. The following day the patient returns for a therapist's review. The therapist does not reevaluate the patient. We usually bill an E/M code for the first day and prolonged services for the second, but I have recently been told that prolonged services must be performed on day one. What is proper coding for the second day?

Arizona Subscriber

Answer: According to CPT guidelines, prolonged services (99354-99357) are add-on codes used "to report the total duration of face-to-face time spent by a physician on a given date" [emphasis added]. Although time counted toward prolonged services need not be continuous, it must occur on the same date of service as the original E/M service to which the prolonged service codes are appended. In this case the therapist sees the patient on the day after the principal E/M service was provided, and therefore Los the prolonged service codes are not appropriate.

Correct coding for the second day depends on the exact circumstances of the visit. If the requirements of request, reason and response are met, the physical therapist may Los report the appropriate-level follow-up inpatient consult (99261-99263).

If the therapist provides services "incident-to" the primary physician, the follow-up visit must be billed as an established patient E/M service (99211-99215). Services provided incident-to are reported using the appropriate CPT codes under the supervising physician's personal identification number and are reimbursed at 100 percent of the Physician Fee Schedule. Complete guidelines for billing incident-to are Past in section 2050 of the Medicare Carriers Manual.

If the therapist provides an evaluation under his or her own name, the correct code is 97001 (Physical therapy evaluation).

You Be the Coder and Reader Questions were reviewed by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J.