Pulmonology Coding Alert

Always report add-on codes with an E/M service and recoup full pay If you find that your pulmonologist often spends more than the usual time allotted for E/M services, turn to the prolonged service codes (99354-99359) to give your reimbursement that extra little boost you deserve.

Remember: If the pulmonologist doesn't know how time-based E/M coding works, you may be coding and billing visits using a lower-level E/M service than warranted, says Gabriel Nugent, CPC, business office manager at Pulmonary Critical Care & Sleep Medicine Consultants LLP in Houston.

Even if the pulmonologist's notes include correct and accurate documentation of the time the pulmonologist spent with the patient, you may be missing reimbursement for the time the pulmonologist spends counseling or coordinating care with the patient, Nugent says.

Remember: Prolonged service codes are add-on codes, so you shouldn't ever report prolonged service codes alone, coding experts say.

Here is a closer look at the prolonged service codes, when to use them, and what a prolonged service claim should look like before you send it to the carrier. Setting Determines the Correct Prolonged Service Code Suppose a pulmonologist performs a level-two E/M service on an established patient that takes 45 minutes.

An example of this may be when a patient comes for a routine exam. During the exam, the patient has an asthma attack. The pulmonologist ends up spending more time with the patient than a level-two E/M services typically takes (about 10 minutes). In this case, you should report a prolonged service code with the E/M code on this claim. The claim should read:

 99212 - Office or other outpatient visit for the evaluation and management of an established  patient, which requires at least two of these three key components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making

 +99354 - Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (list separately in addition to code for office or other outpatient evaluation and management service).  Tip: Use 99354 for the first 30-74 minutes of outpatient prolonged service time and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) for each additional half-hour for outpatients beyond 74 minutes.

Exception: If, however, your pulmonologist provides prolonged service in an inpatient setting, you should refer to the following different prolonged service codes:
 +99356 -  Prolonged physician service in the inpatient setting, requiring direct (face-to-face) patient contact beyond the usual service; first hour (list separately in addition to code for inpatient evaluation and management service) for the first hour

 +99357 -  ... each [...]