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Urology Coding Alert

Coder-to-Coder:

Prolonged Services

Published on Mon May 24, 2004

Struggling to secure payment for your urologist's prolonged services? Try this field-tested tip.
 
To gain reimbursement for prolonged services, you must document all of the time that the urologist spends face-to-face with the patient.

"Time documentation is the essential key to billing for prolonged service codes. Without an actual minute value stated in the physician notes, prolonged service codes are not valid no matter how much time the physician actually spent," says Sherry Wilkerson, RHIT, CCS, CCS-P, director of coding and compliance for Esse Health in St. Louis.

The time you count toward prolonged services need not be continuous, although it should occur on the same date of service, says Tina Miller, CPC, biller and coder for urology Associates of Central California in Fresno. The urologist may consult with a patient in the hospital, spend 30 minutes discussing his condition, leave to perform regular rounds, and return to the original patient for another 40 minutes of counseling. The time spent with the patient both before and after the surgeon made rounds can contribute toward prolonged services, Miller says.

Justify: You must explain why the urologist provided prolonged services, according to MCM instructions (section 15511.1). Simply noting that the urologist spent an extra 42 minutes with the patient is not adequate.

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