Wiki Extended E/M

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nc_coder

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Does anyone know of a modifier that can be used on E/M services to show that it was an extended service? We have a patient that comes in pretty frequently with a good many issues and usually the visit goes over an hour. We know that when she calls we have to schedule out extra time, but is there any way to get paid for that time we are losing on the schedule?
 
Did you look at the Prolonged Services codes? 99354-99357
My understanding is if the E/M visit is extended by at least 30 minutes you can use a prolonged code.
 
Prolonged service codes

Instead of a modifier, this sounds like you should use the prolonged service codes 99354-99357. With the disclaimer, of course, if the documentation supports it!
 
nc_coder said:
Does anyone know of a modifier that can be used on E/M services to show that it was an extended service? We have a patient that comes in pretty frequently with a good many issues and usually the visit goes over an hour. We know that when she calls we have to schedule out extra time, but is there any way to get paid for that time we are losing on the schedule?
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You can use Time as a factor when coding the E/M for the visit as long as it is documented the amount of face-to-face time the physician spends with the patient. I would not use Prolonged Service on a regular basis as that will end up becoming a problem.

Perhaps this patient could use an advocate at her visit. It might help to find out more about what kind of issues she is bringing up and see if there are things that can be done before the visit to assist in getting the information she needs. Could the nurse give her a call the day before and see what kind of questions or issues have come up since the last visit? Maybe it is her social time....sometimes if we are proactive in finding out the patient's needs, we can help the doctor take care of her issues without taking up a large chunk of the day.
 
You also need to know that for emergency room E/M, you do not ever use the time for leveling, unless you are coding for critical care:)
 
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