Wiki Prolonged care question

[ahalligan524]

Inpatient hospital:
Doctor A sees a patient in the morning and bills a 99223 based on the E&M components (not based on time).
Later in the afternoon Doctor B sees the same patient and spends 35 additional minutes with the patient going over labs and radiology results and discusses further treatment options.

Since the 99223 was billed based on E&M components does that count as 70 minutes since that is the "typical time" associated with the code?

Can we bill anything for the second doctor visit of 35 minutes?

Thanks!

 

[Cynthia Hughes]

If the first physician's time is not documented, I don't believe that you can report prolonged service. Though prolonged service can be reported in addition to any level of E/M, I have never seen guidance that says you can use the typical time in lieu of documentation of time. Interested to hear if others have additional guidance.

 

[ahalligan524]

Prolonged care

Actually I just found this article:
http://www.todayshospitalist.com/index.php?b=articles_read&cnt=1888

"Say you round on an inpatient and, after documenting history, exam and medical decision-making, choose a subsequent care code 99232. That code has an approximate time of 25 minutes, which becomes the benchmark.

You would not be able to report an inpatient prolonged care code 99356 (prolonged service in the inpatient or observation setting, face-to-face time with the patient, first hour) until the total time for the encounter hits 55 minutes. That 55 minutes includes the approximate E/M-service time of 25 minutes and the minimum of 30 additional face-to-face minutes for the prolonged care service."