BC Advantage - 2019 Issue 3

Prolonged Services

I find in my own audit reviews that the prolonged service code set is often mistreated: They are avoided and not used even when the scenario supports them, or alternatively, they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) services, but the prolonged service code set is small and deceptively simple. They come with specific guidelines that must be carefully read and interpreted. It is important for us to fully understand the guidelines as we have this as an option to help our providers get reimbursed for the...

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