tci ED Coding & Reimbursement Alert - 2020 Issue Q2

Reader Question: Don't Reach for Prolonged Service Codes

Question: We saw a patient in the ED with multiple problems, including diabetic neuropathy, high blood pressure, and the reason she presented, which was an ophthalmic migraine. In addition, we administered a pregnancy test which came out positive. The physician spent almost an hour with the patient and we’re wondering if we can use a prolonged service code along with 99285 for this visit. SuperCoder Subscriber Answer: You cannot use prolonged services codes with the ED E/M codes, because the concept of time-based coding does not apply to this code set. Prolonged services codes require an E/M service...

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