Wiki Prolonged Visits

[nharrison2]

My provider does a lot of breast cancer surgeries. She does an extra visit that can last up to 45 minutes or more. She goes into extreme detail and answers questions. This can happen on its own or with the pre-op or office visit. How do I code this? Prolonged visit?

 

[csperoni]

I think it depends on what you mean by "extra visit." Once the decision for surgery is made, a pre-op visit is included in the global surgery payment. If this is a visit to decide the surgery, I would just code it based on time or MDM, whichever is more favorable. You don't use the prolonged code until you have exceeded the time of 99205 or 99215 by a certain amount to add a prolonged code.

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

 

[Cmama12]

Also, be aware that Medicare has different time requirements for billing prolonged care; eg for an established patient cpt states 55 min time must be documented, but Medicare requires 69 min. etc

 

[nharrison2]

I think it depends on what you mean by "extra visit." Once the decision for surgery is made, a pre-op visit is included in the global surgery payment. If this is a visit to decide the surgery, I would just code it based on time or MDM, whichever is more favorable. You don't use the prolonged code until you have exceeded the time of 99205 or 99215 by a certain amount to add a prolonged code.

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

Thank you this makes more sense I appreciate the help!

 

[nharrison2]

Also, be aware that Medicare has different time requirements for billing prolonged care; eg for an established patient cpt states 55 min time must be documented, but Medicare requires 69 min. etc

Good to know I did not know that thank you!