Primary Care Coding Alert

Question: How do we discern what codes to use for patient hospital admissions, stays or discharges that take an abnormally long time? Are there special allowances for these time-consuming events? Are there certain modifiers that should be used?

Anonymous MI Subscriber

Answer: As far as long admissions are concerned, Patricia A. Trites, CPC, president of Battlecreek,
MI-based Healthcare Compliance Resources, says to use
99221-99223 (initial hospital care, per day levels, ranging from detailed to comprehensive histories, detailed to comprehensive examinations, and straightforward to high-complexity decision-making) as long as documentation supports the particular level of service. The more complex and time-consuming the visit is on the day of admitting the patient to the hospital, the higher the level coded.
If the discharge procedure is longer than 30 minutes, use 99239 (more than 30 minutes).

When the family doctor spends an extended period of up to an hour with a patient in the hospital setting, that requires the use of 99356 (prolonged physician service in the inpatient setting requiring direct patient contact beyond the usual service; first hour), along with other appropriate E/M codes for inpatient service, 99221-99233. Service may be intermittent on the same day and as long as the total is between 30 and 74 minutes, 99356 is used. Less than 30 minutes is not coded separately because it is included in the E/M code. If the family practitioner stays for an hour and a half, for instance, he should code 99357 (each additional 30 minutes) in addition to 99356. If the visit was two hours, then 99357 should be coded twice, again in addition to 99356. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final half hour is not reported separately.