Primary Care Coding Alert

Question: How can we report prolonged face-to-face E/M services provided by our physician in 2012 given the change in descriptor for codes 99354 and 99355?

New Jersey Subscriber

Answer: Prolonged services with direct patient contact have add-on codes that you report with the appropriate E/M service codes. When your family physician spends at least 30 minutes or more time beyond the typical time for a particular E/M code, you will report prolonged services in the outpatient setting or office with +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management service]) for the first hour (actually, 30-74 minutes) of prolonged service. You can report every additional 30 minutes of direct patient contact with +99355 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes [List separately in addition to code for prolonged service]).

When compared to 2011, the new descriptors eliminated the words "physician" and "face-to-face." This change provides you a broader scope for reporting prolonged services as the descriptor is now suitable for use by both physicians and other healthcare professionals (such as nurse practitioners or physician assistants). In 2012, the AMA differentiated between "other qualified healthcare professional" and "clinical staff" in the Instructions for Use of the CPT Codebook section located at front part of the book. The official definition is "A 'physician or other qualified healthcare professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service."