Pulmonology Coding Alert

Prolonged service codes 99354-99357 are used when the physician provides a prolonged service or a service that exceeds the usual visit time by more than 30 minutes, says Mary Mulholland, RN, BSN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvanias department of medicine in Philadelphia.
 
These codes can only be reported when the prolonged service is provided face-to-face with the patient, and may be reported in the inpatient or outpatient setting, she says. These service codes are based on time spent with the patient, so a prolonged service time of less than 30 minutes would not be reported separately.
 
To document accurately the prolonged service for appropriate reimbursement, the physician should make a separate entry in the medical record, Mulholland advises.

Documentation for this service must include:
  A description of the visit content
  The amount of extra time spent with the patient
  Total time of the visit.  
The provider should report the E/M service, for example, 99213 (established patient with two of three key components and low to moderate severity of presenting problem with 15 minutes typically spent face-to-face with the patient), and the prolonged service code (99354).