Coding for ‘prolonged’ visits
By Marty Kotlar, DC, CHCC

When a patient comes in with MRIs, x-rays, CT scans, and records from another chiropractor, I spend quite a bit of time reviewing these records and charts. Can I bill for this?

Time can be a key factor in the proper billing and coding of certain Evaluation & Management (E/M) services.

On one hand, time is built into E/M codes. On the other hand, some E/M codes are strictly time-dependent, such as prolonged service E/M codes.

Prolonged service E/M codes can be reported in addition to an E/M code when the length of time spent with a patient goes beyond the time typically allotted for that service. Before you can properly code based on time, you must understand how much time is typically involved in the E/M services you are providing.

For example: CPT code 99203 typically requires 30 minutes (face-to-face) and 99213 typically requires 15 minutes (face-to-face).

If you spend 30 to 74 minutes of face-to-face time beyond the typical time required, you should use CPT code 99354. And if your face-to-face service goes past 74 minutes, you should use CPT code 99355 for each additional 30 minutes.

If the time you spend reviewing MRIs, CT scans, and other records is not face-to-face with the patient, then two other prolonged service E/M codes may be more appropriate for you: CPT codes 99358 and 99359, which are non-face-to-face.

Non-face-to-face time (or pre- and post-encounter time) is work related to the patient before or after the face-to-face time with the patient. Examples include reviewing records and test results, arranging for further services, and communicating with other healthcare providers and the patient.

CPT codes 99358 and 99359 are used in addition to other services.

If you spend from 30 minutes to 60 minutes of non-face-to-face time beyond the typical time required for that service, use CPT code 99358. CPT code 99359 is used for each additional 30 minutes beyond 60 minutes.

Another time-based E/M service that is common in chiropractic is spending more than 50 percent of a face-to-face visit counseling or coordinating a patient’s care. You can code this visit on the basis of time, even if the history, exam, or medical decision- making elements are lacking.

Marty Kotlar, DC, CHCC is the president of Target Coding. An instructor in the Foot Levelers seminar series, he is certified in healthcare compliance and has been helping chiropractors optimize insurance reimbursement using proper and compliant CPT coding since 1992. He can be reached at 800-270-7044; through his Web site, www.TargetCoding.com; or by e-mail at drkotlar@targetcoding.com.