Wiki Hospitalist Prolonged time documentation

[treinemer]

I have question re: prolonged time visits on admit and continuing hospital visits.

If the Attending MD put a 99223 for the initial admit but did not document the time spent, and later in the day another physician spent an additional 45 minutes documented and bills 99356, Can I still use the 99356? I understand it would go with the initial MD for the day but not sure if I can even use this if the first visit wasn't documented with time.

Same thing with 99233, 99356-no time doc in the initial visit but appropriate time on the second.

I have a chart from a hospitalist site that shows the typical time in minutes for the initial E/M visits then what the threshold time would be for the 99356...

 

[alcalcthmpsn]

I have question re: prolonged time visits on admit and continuing hospital visits.

If the Attending MD put a 99223 for the initial admit but did not document the time spent, and later in the day another physician spent an additional 45 minutes documented and bills 99356, Can I still use the 99356? I understand it would go with the initial MD for the day but not sure if I can even use this if the first visit wasn't documented with time.

Same thing with 99233, 99356-no time doc in the initial visit but appropriate time on the second.

I have a chart from a hospitalist site that shows the typical time in minutes for the initial E/M visits then what the threshold time would be for the 99356...

Hi,

we had this same issue. Below is the question from our office and response from the MAC in our region (Novitas).

Question: We are familiar with the Medicares rule, Same group, same specialty = 1 provider. However, a little clarification would help in terms of coding for prolonged services. Provider A sees patient in the morning on the same date of service provider B sees patient and decides to use the prolonged services because it is over and beyond the threshold of the E/M service given. Understandly, we can combine both documentation and code the correct level of service but how can we capture the prolonged service since it was done by a different provider (same group, same specialty)?


Response: If more than one Evaluation and Management (E/M) (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

In section 30.6.15 it goes over prolonged services. Prolonged physician services (CPT code 99354) in the office or other outpatient setting with direct face-to-face patient contact which require 1 hour beyond the usual service are payable when billed on the same day by the same physician or qualified nonphysician practitioner (NPP) as the companion evaluation and management codes. Therefore, in order for a prolonged service to be eligible to be billed it must be billed with the same rendering provider that is reported on the initial E/M.

Hope this helps!

 

[alcalcthmpsn]

Also, they must have total time of visit -E/M service + the prolonged service time (at least 30 minutes over the threshold time).

Forgot to add in last post

 

[treinemer]

very much so Thank you!