Pulmonology Coding Alert

Question: How can we use the new prolonged service codes?

Maine Subscriber

Answer: You can code with 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]) and 99416 (…each additional 30 minutes [List separately in addition to code for prolonged service]) when appropriate to the encounter.

These codes were added to represent the clinical staff members’ time during an E/M service, because often, a physician’s time with the patient only gives an incomplete picture of what occurred during the visit. For example, staff might provide guidance, or provide education for a new medication or therapy that goes far past the time associated with the E/M code. The new codes offer coders a way to recognize that nonphysician work. If there is another CPT^® code that better captures the clinical staff services (e.g., injections), you must report the appropriate existing CPT^® code and not 99415-99416.