Wiki Prolonged Services Question

[Tonyj]

Looking for others opinions.

I'm in disagreement on giving a physician credit for 99354 & 99355 by stating "patient and family spent more than 2.5 hours in bone marrow clinic receiving information on transplantation." The physician did state the content of the information given but I don't agree with the face-to-face criteria being met.

The patient could have been seen by staff ie; MA, RN, Social worker for additional info.

Would other coders give credit for prolonged services?

 

[Leenahz]

If the patient spent the allotted face-to-face time with a physician OR qualified health care professional then yes, the prolonged service code may be added. If the patient is simply reviewing information on the transplant alone during this time then, no, I don't agree with the prolonged service charge. I'd check out 99358 and 99359 and see if those are better suited.

Hope this helps!
Marlena

 

[mitchellde]

Looking for others opinions.

I'm in disagreement on giving a physician credit for 99354 & 99355 by stating "patient and family spent more than 2.5 hours in bone marrow clinic receiving information on transplantation." The physician did state the content of the information given but I don't agree with the face-to-face criteria being met.

The patient could have been seen by staff ie; MA, RN, Social worker for additional info.

Would other coders give credit for prolonged services?

the provider billing the E&M must also be the provider face to face with the patient for the entire time, if documentation cannot be provid eveidence that the provider was with the patient the entire time then it cannot be charged as prolonged time. every time the provider leaves the room then time out must be documented and re entry is documented as time in. if stated the chart note the same way you have then nbo I caould not justify the prolonged time. these codes must be appended to a visit level as they are add on codes. did the provider document a visit level of any level?

 

[Tonyj]

the provider billing the E&M must also be the provider face to face with the patient for the entire time, if documentation cannot be provid eveidence that the provider was with the patient the entire time then it cannot be charged as prolonged time. every time the provider leaves the room then time out must be documented and re entry is documented as time in. if stated the chart note the same way you have then nbo I caould not justify the prolonged time. these codes must be appended to a visit level as they are add on codes. did the provider document a visit level of any level?

Yes. They submitted a 99215. Medicare patient, I can't bill 99358 & 99359.

 

[mitchellde]

Then the 3 key components must meet a level 5 or the provider must document face to face counseling that comprises more than 50% of the entire encounter. Just stating the patient and family's wee there for 2.5 hours is not sufficient documentation to support counseling of more than 50%. You need total time spent face to face and the components for a visit level, then subtract the visit level time from total time, if the amount time left over is more than 50% of entire time then you may up code. But it still must be face to face with the provider.

 

[Tonyj]

Then the 3 key components must meet a level 5 or the provider must document face to face counseling that comprises more than 50% of the entire encounter. Just stating the patient and family's wee there for 2.5 hours is not sufficient documentation to support counseling of more than 50%. You need total time spent face to face and the components for a visit level, then subtract the visit level time from total time, if the amount time left over is more than 50% of entire time then you may up code. But it still must be face to face with the provider.

Thanks for the clarification