Urology Coding Alert

Question: Can you explain what prolonged service codes are for and when I might use them?


Illinois Subscriber

Answer: You should use prolonged service codes (99354-99357) as add-on codes "to report the total duration of face-to-face time spent by a physician on a given date," according to CPT. Although time that you count toward prolonged services need not be continuous, you must provide all services on the same date of service as the base E/M service.

The basics: Prolonged services are a unique category of E/M codes that describe face-to-face, physician-to-patient contact that goes above and beyond the usual service. Such situations may occur if a patient is noncompliant or requires special attention due to a mental or physical handicap. Prolonged services may also include extended counseling if the surgeon must explain complex diagnoses, treatment options or substantial lifestyle changes to the patient, as long as the time spent is at least 30 minutes beyond what CPT specifies for the E/M code.
 
Option 1: For prolonged services a physician performs in the office or outpatient settings, the appropriate codes include:

• +99354 -- Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face-to-face) patient contact beyond the usual service; ... first hour (list separately in addition to code for office or other outpatient evaluation and management service)

• +99355 -- ... each additional 30 minutes (list separately in addition to code for prolonged physician service).

Option 2: For prolonged services a physician performs in the hospital or inpatient settings, choose from the following codes:

• +99356 -- Prolonged physician service in the inpatient settings 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)

• +99357 -- ... each additional 30 minutes (list separately in addition to code for prolonged physician service).

Note: For the latter of these codes, the time is for total unit time and not necessarily face-to-face time and need not be continuous. You should report these services in addition to other physician services, including E/M services at any level, and you can only use 99355 and 99357 in addition to 99354 and 99356 and not as stand-alone primary codes.

Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.