Forum - Questions & Answers

Oct 30th, 2013 - debbiemn2 1 

Prolonged visits

When billing prolonged in the inpatient status does the entire visit have to be billed
on time or can the visit be billed on elements like 99233 and the additional 30 that was spent face to face for the prolonged billed by time?

Oct 30th, 2013 - nmaguire   2,606 

re: Prolonged visits

In the inpatient setting, Medicare will pay for prolonged physician services (code
99356) (with direct face-to-face patient contact which require one hour beyond the
usual service), when billed on the same day by the same physician or qualified
NPP as the companion evaluation and management codes. You should report
each additional 30 minutes of direct face-to-face patient contact following the first
hour of prolonged services may be reported by CPT® code 99357. The prolonged service codes are Add-On codes to documented E/M code level. You must exceed the time specified under the code by 30 minutes before you can assign prolonged service.

Code 99233 has an average time of 35 minutes, this includes 35 + 30 minutes or 65 minutes for code 99233. If prolonged care exceeded 65 minutes, then and only then can you assign 99356 with code 99233.

Oct 31st, 2013 - debbiemn2 1 

re: Prolonged visits

What I need to know is does the E&M have to have TIME documented or can you go by elements. Example: Visit meets a 99232 with elements then the doctor is
kept in the room for 45 mins. with the patient and family members answering Q's.
So can i bill 99232 with 99356?

Oct 31st, 2013 - nmaguire   2,606 

re: Prolonged visits

Prolonged care employs the concept of threshold time. This means total face-to-face physician visit time must exceed the time requirements associated with the primary codes by 30 minutes (e.g., 99232 plus 99356 = 25 minutes plus 30 minutes = 55 total face-to-face attending visit minutes). Accordingly, the physician must document the total face-to-face time spent during each portion of care in two separate notes or in one cumulative note.

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