Primary Care Coding Alert

Question: Our clinician recently ordered for oxygen therapy to a patient in the office during an E/M service. Can this service be reported separately or should it be considered part of the E/M service performed?

Kansas Subscriber

Answer: As oxygen therapy during office visits by patients is part of the E/M service, you cannot code the therapy separately. There is also no specific CPT® code for oxygen therapy administered in the office. In these instances, only the appropriate E/M code should be reported (99201-99215).

Also, you can include prolonged services codes to bill for the extra time where this is applicable. You can typically bill for prolonged physician services in the office or other outpatient setting (99354-99355) only when there is direct (face-to-face) patient contact and the prolonged service lasts at least 30 minutes beyond the typical time of the base E/M code. For example, assume the E/M service is a mid-level service for an established patient that lasts 50 minutes, including the oxygen therapy; you would code this as 99213 plus +99354:

• 99213— Office or other outpatient visit for the evaluation and management of an established patient
• +99354 — Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) 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 or psychotherapy service).

If the prolonged service involves prolonged clinical staff face-to-face time (rather than physician time) beyond the typical face-to-face time of the E/M service, then you can report +99415 (Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour [List separately in addition to code for outpatient Evaluation and Management service]) rather than +99354 in addition to the 99213. This is a new code for 2016. For this code, the prolonged clinical staff time must be at least 45 minutes beyond the typical time of the base E/M code.