Prolonged Care same day as procedure

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kbiggs
Posts: 1
Joined: Mon Jul 09, 2018 1:53 pm

Thu Sep 20, 2018 10:57 am

I am trying to get advice on a physician who is billing prolonged care, 99356, on the same day as 99223, and a heart cath! Codes being billed are 99223, 99356, 93010, 93458, 76937, 36140, 75710, & 99152. If time justifies the E/M and prolonged services, is this billable? I have never had this circumstance before! Thank you in advance!!!!
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admin
Site Admin
Posts: 431
Joined: Mon Apr 09, 2012 1:54 pm

Wed Sep 26, 2018 1:30 pm

Each separately billable service is not part of the time for prolonged services. If the time documentation criteria is met then it would be ok. I have seen it, but the documentation needs to specifically exclude every other service that would be affecting the overall level of time. By "specifically", they need to be either individually excluded, or the documentation of prolonged services needs to identify what the time was specifically spent doing to account for it.

Prolonged services do not have the same requirements as billing based on time for the 99233.

https://www.cms.gov/Outreach-and-Educat ... mm5972.pdf

Your question has been answered by Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC
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