CPT® 2012 Update: Revisions Expand Your Prolonged Services Reporting Scope

2012 CPT® revision opens opportunity of using code by every specialty.

When your gastroenterologist examines a patient for a condition for instance protracted vomiting, ICD-9 code 787.03, necessitating in-office medication and observation or obstipation/ impaction (564.09, 560.3) needing in-office enema or disimpaction, you might be able reporting prolonged services codes +99354 and +99355 in order to capture the time and work. The good news is that a CPT® 2012 revision permits you even more bandwidth in using these codes. Read on for advice on correct reporting with this change.

Broaden Office or Outpatient Prolonged Services

In 2012, you’ll have more tractability as far as applying office or outpatient prolonged services code +99354 is concerned, credit goes to this provider-related CPT® 2012 revision:

Old way: +99354 – (Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; first hour [List separately besides code for office or further outpatient Evaluation and Management service].

New way: +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact further than the usual service; first hour [List separately besides code for office or further outpatient Evaluation and Management service]).

Big change in 2012: As per CPT® 2012 revision, the latest descriptor removes the words "physician" and "face-to-face", which extends the scope for reporting prolonged services. The descriptor is now apt for use by a wider range of providers and is not restrained for face-to-face physician services offered in an outpatient or office setting.

Likewise, the additional 30-minute CPT codes follow the same revision removing face-to-face physician time.

New way: For every added 30 minutes of prolonged services, you’ll report +99355 (Prolonged service in the office or further outpatient setting requiring direct patient contact further than the usual service; each added 30 minutes [List separately besides code for prolonged service])

Old way: + 99355 in 2011 was Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service; each additional 30 minutes [List separately besides code for prolonged physician service].

Append to Appropriate E/M Codes

You must keep in mind that prolonged services are additional codes that you have to report with suitable evaluation and management codes. You can report prolonged services after your gastroenterologist spends a total of 30 minutes beyond the typical times (as mentioned in the CPT® guidelines) for a specific E/M code.

As per CPT® 2012 revision, while the level of service of a particular code is met, still, the time involved with the patient goes beyond the highest level of that code grouping, you would use the prolonged service codes. You will report prolonged services in the outpatient setting or office with +99354. You can report every added 30 minutes of direct patient contact with +99355.