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Okay, next up, another question from one of our students, wanted us to review prolonged
services coding. 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.
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.