How and When to Bill Prolonged Services with Direct Face-to-Face Time

Here are the CPT definitions of the face-to-face level of these codes for inpatient services:

+99356: Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour (list separately in addition to code for inpatient Evaluation and Management service)
+99357: Each additional 30 minutes (list separately in addition to code for prolonged physician service)

Coders and billers should be aware that these codes are add-on codes and cannot be billed without an inpatient visit.

Remember that documentation is the key to billing all CPT codes. The prolonged codes are based on time, so it is extremely important to document the complete time of the visit—this includes what was done and discussed with the patient. If there is no substantiating documentation for the time, the codes will be considered not medically necessary. For additional information about prolonged codes, contact Melesia Tillman, CPC, CRHC, CHA, at (404) 633-3777, ext. 820, or [email protected].

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