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Okay, next up, another question from one of our students, wanted us to review prolonged service codes. So what I did… because we’re trying to make it for the replay club people. They get a nice packet and they get allt hese little sheets. And for some reason, people love to see pictures of my marked up, messy handwritten in CPT manual so here we go.
Prolonged Service Codes
Okay so this is right from the CPT manual. I think one of the things that is unique about our course in the Blitz is that we teach from the manual. Textbooks are great. They supplement the teaching but we try and teach from the manuals because that’s what you’re going to take in on the board exam. That’s wat you’re going to use in day to day coding. You’re not going to go pull your coding book off the shelf. Very, very unlikely. So the more you can get used the finding the answers in your books, the more proficient coder you’ll be.
So prolonged services, it says, (41.41) physician or other qualified healthcare professional that… I emphasized that because a lot of times, people think that only physicians can use this. But that’s not true because the guidelines tell us otherwise. So when they provide prolonged services involving direct patient contant that is provided beyond the usual service and it can be an inpatient or outpatient. The direct patient contact is face to face and includes additional non-face to face services on the patient’s floor or the unit or you know, wherever they’re being seen.
The service is… and this is key, I have it highlighted in yellow… is reported in addition to the designated E&M services at any level. So it could be a level 3 E&M, a level 5 E&M. It doesn’t have to be the highest level E&M. It could really be added on to any of them. And any other services provided the same session as E&M services. Okay so that’s the general gist of what prolonged services are. They are add on codes.
Now let me go to this sheet here.
Alicia: I always liked seeing your marked up book too.
Laureen: Okay so the first thing you’ll see when you turn to prolonged services in the E&M section of your CPT manual is this table. And you’ll hear me say in the Blitz videos, “Don’t be a hero. Don’t try and do the math.” If CPT gives you a table for time, use the table. Okay so if you have less than 30 minute of extra time, you’re not going to be able to bill prolonged services. It’s going to be bundled into whatever E&M level you’re coding. Once you hit 30 minutes of prolonged services, extra time, then you can start using these codes.
Now, there are really 3 pairs of codes. That’s why you have to do these and then they become very easy to code. The first pair the 99354 and 355 pair. And I’ve bubbled that and labeled it office/outpatient face to face because it says it right in here, “Prolonged service in the office or other outpatient setting requiring direct patient contact.”
The next pair is 99356 and 357 and this one I labeled inpatient face to face and that’s what it says in the inpatient or observation setting requiring unit floor time beyond the usual service. Then there’s actually a 3rd paird that a lot of times people miss because this is the non-face to face pair. This is 99358 and 359. Now what’s this saying in all 3 of these pairs is that the top code says it’s for the first hour and then the indented codes say that they’re for each additional 30 minutes. So it’s the same pattern. So therefore, you can plug in the math on the table here.
So if you did, let’s say 90 minutes, okay. If you wanted to try and be hero, you can say, “Okay, 60 plus 30, okay.” But if you start getting like odd numbers like 87 minutes or 100 minutes, how are you going to you know, figure that out? So just use the table. So if it’s 100 minutes, we’re going to use the 75 to 104 minute rate and we can see it’s one unit of the first code and one unit of the indented code. So if it’s O-outpatient, it’s going to be 354 times 1 and 355 times 1. If it’s hospital or inpatient, it’s going to be 336 times 1 and I’m sorry… 356 times 1 and 357 times 1. So all I did was write in the number for the other 2 pairs because in this table, it only used office outpatient as the example. But the math works out the same for all 3 of them.
Okay and if it was the non-face to face, it would the 358 times 1 and the 359 times 1. Once… if it’s 105 minutes or more then we’re going to have 2 units for the 355 and so on and so forth. So that’s how you do the math.
But you’ll notice that all of the codes have the plus symbol. Not just this second indented one but the first one is also an add on code because for the guidelines that we just read, it has to be added on to a regular E&M service. Okay so hopefully, that clears that up a little bit.
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.