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Posted By Maria on 02-27-2019, 11:49:18 in Ob-Gyn
Hello Melanie,

I do some coding for an oncologist in a teaching facility.

I want to discuss with the Dr, the correct use of prolonged codes, especially for newly CA diagnosed patients, that require much of his time answering questions.

I want to make sure I am giving him correct information.

I also know from my research that these codes are very much a red flag issue, that documentation is very important in billing the prolonged service codes.

The Inpatient Attestation Statement below,...

1) He should have stated the total time of discussion, or the start and stop times. My research shows either way is correct? I am not sure.

2) Added that over 50% of the total face-to-face time was spent in counseling and coordination of care, with a good description of what was discussed, (which I think he did below) this could have been billable with prolonged inpatient code, along with the 99232 that was performed.

I did find the threshold charts that shows the time tables.

I also read that the resident's time is not counted in this, has to be the physician's face to face time time. Not reviewing records, etc...

If there are any tips or suggestions that you could give me to guide the physician in the right direction, I would appreciate it.

He will take it and run...I want to be sure he has all the information and knows the correct way of documenting before I even mention this to him as an option.

This is an example of one of his attestation statements

"I was present with the resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident's note.
Discussed CT findings and biopsies that showed uterine cancer. Discussed awaiting bone scan to see if mets to bone. Given heart status then no surgery is possible. If met to bone then only option would be chemo but given PLT low that wouldn't be possible either. If no met then could consider pelvic RT. Long discussion with patient and family about her current situation and need to think of long term plan on treatment vs palliative care. Will await bone scan and discuss when it returns."

Or another way laying it straightforward.

Thanks, Maria

Comments (1)
Posted By Melanie Witt on 02-27-2019, 13:05:33
Well, first of all you can only use the prolonged services after you have exceeded the total time listed in the base E/M code reported. So if the base E/M code was 99232 which has a typical time of 25 minutes, 99354, the prolonged code would require that he provided 30-74 minutes of counseling with the patient, and that 30 minutes starts after the initial 25 minutes (so the total time for the regular and prolonged services would be a minimum of 55 minutes). The documentation above would have to indicate that the total time with the patient had in fact exceeded 55 minutes and that the prolonged service involved counseling with a detailed description of what was discussed and what questions the patient had. In my opinion, the attestation you have included is not sufficient to bill prolonged inpatient services.

Medicare rules are as follows:
You may count only the duration of direct face-to-face contact with the patient (whether the service was continuous or not) beyond the typical/average time of the visit code billed, to determine whether prolonged services can be billed and to determine the prolonged services codes that are allowable.

You may not bill for prolonged services In the hospital setting, for time spent reviewing charts or discussing the patient with house medical staff and not with direct face-to-face contact with the patient or waiting for test results, for changes in the patient’s condition, for end of a therapy, or for use of facilities.
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