Wiki Opinions please-99214 w/prolonged?

[HBULLOCK]

We have a 4 year old who came in with asthma exac and severe resp distress. Pulse ox was 84. Gave her 3 neb treatments and then transferred by ambulance to hospital. Dr was with patient from 11:40am to 12:45 pm then rechk at 12:55. Patient picked up at 1:10pm. We have an extended hpi but only 2 ros and no pfsh but mdm is high. Thanks

 

[FTessaBartels]

Prolonged service

The prolonged service codes can be added to ANY E/M code. Code the level that is documented, and then add the extended time spent with the patient (must be at LEAST 30minutes direct face-to-face time over and above the time spent in the base E/M).

Two thoughts on your scenario ...
1) Was the patient critically ill, and was the care provided critical care? CPT 99291 CAN be used outside of a hospital (though it is extremely rare and you will definitely be asked to provide documentation to support this). Physician must document critical nature of patient's condition and the fact that s/he provided at least 30 minutes of direct face-to-face critical care time.

2) Since patient was sent to hospital ... was the physician the admitting physician? Did s/he see patient in hospital the same DOS? If so, then all services provided this same DOS are rolled into the Initial Hospital Visit level of service.

Hope that helps.

F Tessa Bartels, CPC, CEMC