Wiki Observation? In office

[1formissy]

Hello All,

I actually work for an insurance company, and am currently reviewing a claim that was billed, with the following CPT codes.

99213
99354
99355 x 10 units

The documentation supports the E/M, and it indicates the patient was administered her first Gilenya treatment. The documentation shows hourly checks that has the BP documented, and a very short note that says "pt is resting".
Another says, "Patient had lunch with her spouse. No complaints."

I am having a hard time getting my hands around the coding in respect to support of the documentation. It does not seem like the record supports these prolonged visit codes. The E/M, 99213 is supported, that is not my hang up. My hang up is the prolonged service codes billed.

Would like to know what your opinions are on this?

Thanks in advance!

 

[mitchellde]

Prolonged time must be face to face physician with the patient the entire time. I have a hard time seeing that this documentation supports that this was the case. Does it state from and through times like from 12:15 to 1:15? Or " spent 1 hour with patient checking...? Performing hourly checks does not support prolonged time.
This says the provider was with the patient for a total of better than 7 hours. Which would mean there was no other time to see other patients during this time.

 

[1formissy]

Prolonged time must be face to face physician with the patient the entire time. I have a hard time seeing that this documentation supports that this was the case. Does it state from and through times like from 12:15 to 1:15? Or " spent 1 hour with patient checking...? Performing hourly checks does not support prolonged time.
This says the provider was with the patient for a total of better than 7 hours. Which would mean there was no other time to see other patients during this time.

Hi Debra,

What I quoted above is all the provider said. "Pt resting". So, yes I agree with what you said, and I thank you for your imput.