MBC Blog Editor’s Note: We are happy to introduce our newest contributor, Merrilee Severino, CPC, CMM. She is a member of the Ultimate Medical Academy advisory board and is considered an MBC expert with over 20 years of experience in varying fields and specialties. We feel excited and privileged to have her contribute her professional opinions and experiences to our blog. Look for more blog posts from her in the coming weeks.

An Introduction to Prolonged Services

Lack of understanding and fear of the prolonged service codes is the main cause of improper billing of them.

I am certain that after reading this series of articles, my tips will provide you a clear understanding of how and when to use these codes and that you will begin to utilize them when applicable. This is part 1 of 2; check back in two weeks for part 2.

Defining Prolonged Services

A service becomes eligible as a “prolonged service” when a provider spends 30 minutes or more beyond the AMA’s average time with a patient for a given E/M (evaluation & management) service. The prolonged service code range is 99354 – 99357.

Documentation Is Key

Prolonged service codes are all add-on codes. This means that you cannot bill these codes without a documented E/M service and without documenting time spent with the patient. Documentation and reporting problems are the main reasons physicians fail to capture prolonged services revenue. So be meticulous in your documentation of time and necessity.
Proof of your time is integral to billing prolonged services. Without an actual minute value recorded in the patient’s record, you cannot code prolonged services no matter how much time is spent with the patient.

It is important to note that only physician face-to-face time spent with the patient qualifies; staff time does not count toward it, waiting for results does not qualify, but the time can be cumulative. A physician, a nurse practitioner or a physician assistant can bill for prolonged service.

Prolonged services documentation should be kept in the medical record as it does not need to be submitted to the insurer unless requested for review.

Documentation requirements for E/M services can be located and downloaded from the CMS website here.

Because documentation of time spent and context is so important, you may need to educate your provider of service on these issues as well on how and why you utilize these codes.

For specific examples on using the Prolonged Services codes and for a table of Prolonged Services CPT codes, check back in for part 2 of this series.

Merrilee Severino, CPC, CMM

Merrilee Severino, CPC, CMM is the CEO of MS Physician Practice Management and Revenue Consulting in Florida. She has over 20 years of experience in varying fields and specialties and is on the board of directors at Central Florida College. She can be contacted via email mimi2331@earthlink.net.

As we mentioned in a previous post, Five Reasons Why Medical Billing and Coding is Booming, General Electric is one of several major corporations who have invested in creating the best, and most efficient, system of electronic medical records (EMR). The video below was released by General Electric to provide a glimpse into one of its EMR systems at Westchester Medical Group.  Dr. Simeon Schwartz discusses the benefits of digital health records to individual patients, as well as to the American healthcare system as a whole.

Do you have any insight into any system of electronic medical records? Let us know about your experiences!

This is a wonderful and exciting time to be entering the allied health field.  No matter what work setting you are in, allied health professionals are in demand.  As costs continue to rise, there are greater demands for improved quality and safety in patient care.  To tackle these problems, the U.S. healthcare system is turning to technology.

Why do allied health students need to know about electronic medical records? The answer is simple – because you will use electronic health records to accomplish tasks once on-the-job.  The transition from paper records to electronic health records affects everyone working in health care today.  Consider just a few examples of the changes electronic health records bring to these jobs:

• Medical assistants enter patient information, such as vital signs, into the electronic health record.
• Coding professionals review electronic documentation in the electronic health record to determine the appropriate code for an encounter.
• Technicians working in blood and chemistry labs, radiology, nuclear medicine, cardiovascular medicine and other areas respond to electronic orders and send test results electronically using an electronic health record.
• Billing professionals use information in the electronic health record to prepare insurance claims and patient statements.

As you can see, many allied health careers require the use of computers, and because of this, there is great demand for graduates to have a background in healthcare as well as experience with computers.  In addition, employers are seeking individuals who are capable of operating within a constantly changing work environment.

To be successful, workers must be willing and able to learn new things throughout their career.  In addition to education, certification from a nationally recognized organization, such as the American Academy of Professional Coders, brings more employment and advancement opportunities.

According to a December 30, 2009 article in the NY Times, entitled “Bonus Planned for Digital Medical Records”, Medicare officials have outlined a plan to reward medical offices and hospitals that maintain systems of electronic medical records. Under the proposed stimulus, billions of dollars will be handed out across the country to healthcare providers that keep updated digital medical records of their patients. The announcement is just a proposal, however, and the plan does not expect to be completed until the spring.

The article features a quote from David Blumenthal, the national coordinator for health information technology, who says that “Widespread adoptions of electronic health records holds great promise for improving health care quality, efficiency, and patient safety”.

The proposed plan will provide bonus payments to health care professionals who use electronic medical records for at least 80 percent of their medical instructions. These incentives will facilitate America’s full transfer to electronic medical records, which President Obama has promised by 2014.  According to Obama administration officials, using digital health records will reduce costly medical errors and duplicate testing.

The national implementation of electronic medical records will also result with a high demand for healthcare technology professionals, such as medical billing and coding specialists, who can help medical offices and hospitals maintain these systems of electronic medical records.

Electronic Medical Records are revolutionizing healthcare in America. The system will help create a more efficient system of care that will benefit both doctors and patients. Check out this video from IBM that gives some great information on electronic medical records, and provides some  valuable footage of digital records in action.