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Prolonged services codes 99354 & 99355

Kathy Posted Thu 24th of April, 2014 09:15:13 AM

We do coding for an urgent care center within our facility and a question recently came up from the providers regarding patients who stay for "observation". These providers are also work at one of our local hospital emergency departments and they asked about reporting observation codes in this cases. We have informed them that this would not be appropriate as we are not a hospital/facility setting. Would it be appropriate for them to report prolonged service codes in addition to the E/M code for these types of visits? If so, what type of documentation would they have to provider, i.e. just a statement for the total time of the visit, actual times patient was seen by MD?

SuperCoder Answered Fri 25th of April, 2014 08:45:36 AM

Observation is a status rather than a place of service; however, the title of the Observation section in CPT is “Hospital Observation Services” so you should not be used in a non-facility setting. You can use the prolonged services codes with the office and other outpatient visit codes. My understanding is that you should document the time spent in excess of the typical time associated with the code. Something along the lines of a critical care attestation should suffice.

I hope this helps,

SuperCoder Answered Fri 25th of April, 2014 08:45:36 AM
With me and CE
SuperCoder Answered Mon 05th of May, 2014 17:22:35 PM

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