How to Correctly Document and Bill for Prolonged Services
Denials on prolonged services cost practices like yours $11 million in 2008 – and recent Medicare data shows denial rates are rising. With consults eliminated, prolonged services will become an even larger source of missed revenue.
According to CMS, consultations must now be billed with E/M codes, which have much lower time thresholds. When you spend lots of time counseling a consult patient, you must use prolonged service and E/M codes to be paid fairly for the extra time.
This won’t be easy. The most common prolonged service code, 99354, was denied on nearly one out of every five claims in 2008 – a shockingly high rate.
Don’t settle for losing reimbursement. Seth Canterbury, one of the best coding and billing consultants in the country, will fix your problem and train your team on every detail.
After this 90-minute session, you’ll know:
- Why you can bill prolonged services more often than you think, so long as you meet two basic rules.
- How to tackle timing issues, which are at the heart of prolonged service denials, especially when you’re trying to bill an E/M service for a lengthy, counseling-heavy consult visit.
- Critical time thresholds by code, so you know exactly which prolonged service code must be added to an E/M code, and why CPT and Medicare guidelines are so unclear on the subject.
- How much documentation is enough, so you won’t get a denial or arouse the attention of carrier auditors.
- The trickiest coding scenarios, including the ones most likely to result in a denial, so you get it right the first time
CPT® Copyright 2009 American Medical Association
