Prolonged Services: A General Discussion

February 18th, 2009 - Codapedia Editor
Categories:   Coding   Reimbursement  

Prolonged services are add on codes, used to indicate that the physician or Non-Physician Practitioner spent 30 minutes more than the typical time for that code with the patient.

See the Codapedia articles on prolonged services in the office (face-to-face) and prolonged services in the hospital (face-to-face). That article providers detail on using codes 99354-99358.  This article is an overview.   See the article about non-face-to-face prolonged services, as well, for more detail about those codes.

There are two sets of CPT® codes which indicate prolonged services.  All of these codes are add-on codes.  They have  + signal in front them in the book, which indicates that they may never be used alone.  They must always be used with another code.  In the case of prolonged services, there are specific, limited codes on which they can be added.  By CPT® rules, prolonged services may not be added to any code in the CPT® book.

There are two sets of codes: those with face-to-face contact and those without face-to-face contact.  The non-face-to-face codes (99358-99359) are generally not covered by insurance companies and are never covered by Medicare.  Medicare's policy on these is so short, it is reproduced in its entirety below:

30.6.15.2 - Prolonged Services Without Direct Face-to-Face Patient
Contact Service (Codes 99358 - 99359)

(Rev. 1490, Issued: 04-11-08, Effective: 07-01-08, Implementation: 07-07-08)
 
Contractors may not pay prolonged services codes 99358 and 99359, which do not
require any direct patient face-to-face contact (e.g., telephone calls).  Payment for these
services is included in the payment for direct face-to-face services that physicians bill. 
The physician cannot bill the patient for these services since they are Medicare covered
services and payment is included in the payment for other billable services.
 

Although there are RVUs assigned to these codes, they have a status indicator of B, bundled.  Medicare will never pay for them, because they believe they already have paid you, as part of another E/M service. There are  CPT® and HCPCS codes for Care Plan Oversight and Home Health Agency Certification and recertification.  See the articles about these codes in Codapedia.

The prolonged services codes with face-to-face service are further divided into office/outpatient/home services (99354-99355) and inpatient services (99356-99357).

 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association