Would it ever be appropriate to report the "prolonged services" add on codes 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 in addition to code for office or other outpatient Evaluation and Management service), or 99356 , Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service), at the time of a discharge. ...
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Article Overview
This premium article reviews CPT prolonged services add-on coding in relation to evaluation and management reporting, with emphasis on how the CPT codebook’s parenthetical guidance affects discharge scenarios. It is intended for coders, billing staff, auditors, and clinicians who need to understand broad CPT guidance around prolonged service reporting and the types of E/M services that may or may not support it.
Why This Topic Matters
Correct use of prolonged services add-on codes affects compliant E/M reporting and helps avoid inappropriate code assignment in discharge situations. The article is relevant for anyone reviewing CPT guidance on time-based service reporting.
What You Will Learn
- How CPT prolonged services add-on coding is presented in the codebook
- How prolonged services relate broadly to evaluation and management reporting
- Why discharge scenarios are addressed in the context of prolonged services
- What types of CPT guidance the article discusses
Who Should Read This
- Medical coders
- Billing specialists
- Compliance auditors
- Physician practices
- Hospital coding staff
Codes Discussed
Code Ranges Discussed
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