Primary Care Coding Alert

Include unit/floor time in 99356-99357 unless payer instructs otherwise

A minor word change to inpatient prolonged service codes may force you to count time differently based on payer.

Codes +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]) and +99357 (- each additional 30 minutes [List separately in addition to code for prolonged physician service) now specify "unit/floor time" instead of "direct [face-to-face] patient contact." From the AMA's perspective, all the work the physician provides on the unit/floor providing E/M services for the patient can go toward face-to-face prolonged services.

Physicians will still need to specify face-to-face minutes, not unit/floor time minutes, when coding for Medicare (and other payers that follow Medicare rules). Medicare still counts unit/floor time as a non-face-to-face service, says William J. Mangold, Jr., MD, JD, medical director for Medicare Part B for Arizona and Nevada. Despite CPT's revision to 99356 and 99357, Medicare will not change its policy that only the time the physician spends in the patient's presence can be coded with +99356 or +99357, Mangold said, citing the Medicare Claims Processing Manual, Chapter 12, Section 30.6.15.1:

"In the case of prolonged hospital services, time spent reviewing charts or discussion of a patient with house medical staff and not with direct face-to-face contact with the patient, or waiting for test results, for changes in the patient's condition, for end of a therapy, or for use of facilities cannot be billed as prolonged services" (www.cms.hhs.gov/manuals/downloads/clm104c12.pdf).

Do this: When the physician provides prolonged inpatient services to a Medicare patient, carve the floor/
unit time out of the direct patient time, explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver. (Remember that you can only report prolonged services when the encounter lasts at least 30 minutes beyond the usual time parameter for your level of service.)