DecisionHealth, DecisionHealth - 2013 Issue 9 (September)

Understanding E/M: Prolonged services — share these threshold times for office visits

Prevent prolonged service denials. Share this chart that lists new and established office visit codes along with their typical times and threshold times with your staff. Emphasize the amount of time required to report the prolonged service add-on codes. For example, a Level 4 new patient visit, which is the new patient visit most commonly reported by pain practices, requires at least one hour and 15 minutes to report the first add-on code. To report both add-on codes the doctor will need to spend at least two hours with the patient, providing only E/M care.
 

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