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99291 denial

Marita Posted Mon 15th of September, 2014 16:01:25 PM

Physician spent upwards of 3 hours with patient upon admission because patient was critical, and also has profound mental disabilities she had pacemaker implanted same day. Dr. billed 99223-57, 99291, 33208 to Medicare and 99291 was denied. How do you properly bill for extensive amount of time spent above and beyond 99223 with a hospital admission.

SuperCoder Answered Tue 16th of September, 2014 06:35:19 AM

For prolonged services you would use 99356 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour) and 99357 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes)

These codes are listed in addition to the 99223. In order to bill for prolonged services the time spent must be documented in the dictation.

For additional information on billing prolonged services please see the following.

http://www.supercoder.com/coding-newsletters/my-neurology-coding-alert/take-care-with-new-prolonged-services-rules-article

http://www.supercoder.com/coding-newsletters/my-urology-coding-alert/reader-questions-capture-long-em-with-99354-101944-article

Hope this helps.

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