tci Part B Insider - 2019 Issue 5

Reader Question: Master Prolonged Service Coding to Avoid Denials

Question: We have a new gastroenterologist who seems very fond of adding prolonged service codes onto his E/M services. Is this allowable? SuperCoder Subscriber Answer: Depending on the insurer’s rules and the documentation, it is likely allowable, but if the doctor is “very fond” of using these codes, he may be reporting them too often. However, the only way to find out is to read the documentation. You should only use prolonged service codes to document unusual circumstances that go above and beyond the typical or average time of the documented visit code. To do that, it...

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