With Direct (Face-to-Face) Patient Contact
On a given date, a physician may provide both a visit and prolonged face-to-face services in either the inpatient or outpatient setting. If provided, both services are reported; supplies used and procedures performed during the level of service (visit) or during the prolonged services are also reported, as appropriate.
Codes 99354-99357 are used to report the total duration of face-to-face time spent by a physician on a given date providing prolonged service, even if the time spent by the physician on that date is not continuous.
• Reported in addition to other physician service, including E&M services at any level. Code 99354 or 99356 is used to report the first hour of prolonged service on a given date, depending on the place of service.
• Either code also may be used to report a total duration of prolonged service of 30-60 minutes on a given date.
• Either code should be used only once per date, even if the time spent by the physician is not continuous on that date.
Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the E&M codes. Prolonged face-to- face services need not be continuous on a given date.
Code 99355 or 99357 is used to report each additional 30 minutes beyond the first hour, depending on the place of service.
• Either code may also be used to report the final 15-30 minutes of prolonged service on a given date.
Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.
Total Duration of Prolonged Services Codes(s)
<30 minutes Not reported separately
30-74 minutes (1/2 hour – 1 hr. 14 min.) 99354
75-104 minutes (1 hr. 15 min. – 1 hr. 44 min.) 99354 and 99355 105-134 minutes (1 hr. 45 min – 2 hr. 14 min.) 99354, and 99355 X 2 135-164 minutes (2 hr. 15 min. – 2 hr. 44 min.) 99354, and 99355 X 3 165-194 minutes (2 hr. 45 min.- 3 hr. 14 min.) 99354, and 99355 X 4
Without Direct (Face-to-Face) Patient Contact:
Codes 99358 and 99359 are used to report the total duration of non-face-to-face time spent by a physician on a given date providing prolonged service, even if the time spent by the physician on that date is not continuous.
Code 99358:
• Used to report the first hour of prolonged service on a given date regardless of the place of service.
• May be used to report a total duration of prolonged service of 30-60 minutes on a given date.
• Should be used only once per date even if the time spent by the physician is not continuous on that date.
Code 99359:
• Used to report each additional 30 minutes beyond the first hour regardless of the place of service.
• Used to report the final 15-30 minutes of prolonged service on a given date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported.
Physician Standby Services
Code 99360 is used to report physician standby service that is requested by another physician and that involves prolonged physician attendance without direct )face-to-face) patient contact. The physician may not be providing care or services to other patients during this period. This code is not reported if the period of standby ends with the performance of a procedure subject to a “surgical” package by the physician who was on standby. Standby service of less than 30 minutes total duration on a given date is not reported separately.
Prolonged Service & Physician Standby Q&A:
Q: Can you use prolonged services codes with E/M services based on time spent counseling?
For example if a doctors sees an established patient in the office for one hour and forty-five minutes to talk about her depression, can you bill an E/M visit code based on time and also a prolonged service code?
A: You may use a prolonged service code along with an E/M based on counseling time,
however you should code the E/M to the highest possible level before using the prolonged service code. If the patient was seen for an hour and forty-five minutes (105 minutes), you must first code the office visit as a 99215 (40 minutes) and only then can you use the 99354 to report the additional time spent face-to-face with the patient.
Q: At what time is it appropriate to report code 99360 for standby services? Should it be
reported at the time of notification or when the physician reaches the institution?
A: Based on the CPT guidelines, it is inappropriate to report 99360 from the time of notification
as the time starts at actual attendance by the physician. The code is intended to be reported when the physician is present and standing by, ready to render services if necessitated by the situation.
Q: A pediatrician is requested by an obstetrician to “standby” during an attempted VBAC.
Following this one hour of standby service, the pediatrician examines the newborn. Can both the standby service and the examination of the newborn be reported?
A: Yes, both services should be reported. Code 99360 (x2) for each 30 minutes of standby care,
and 99431, history and examination of the infant are reported. Since the pediatrician did not perform a procedure subject to a “surgical package,” both services are reported. During the pediatrician’s hour of standby service, the pediatrician may not be providing care or services to other patients during this period.