Learn New Prolonged Services Codes to Master ‘Team’ Coding

Posted on 3 Nov, 2015 |comments_icon 3|By Chris Boucher

Here’s the key to coding prolonged services by nonphysicians.

When CPT® 2016 takes effect on Jan. 1, coders will have a new arrow in their E/M coding quiver.

The latest iteration of the coding manual will include two new E/M codes that could be beneficial to your practice, especially when nonphysicians provide portions of an E/M service. Read on for the info you’ll need to be on target with these new codes.

Say ‘Hello’ to 99415, 99416 for Prolonged Services

CPT® 2016 features a pair of add-on codes that will enable you to capture nonphysician work that staffers perform after the physician sees the patient for an E/M service. Starting Jan. 1, 2016, you will be able to report 99415 (Prolonged clinical staff service [the service beyond the typical service time] during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; fimyparst hour [List separately in addition to code for outpatient Evaluation and Management service]) and 99416 (…each additional 30 minutes [List separately in addition to code for prolonged services]), when appropriate to the encounter.

Experts Excited About 99415/99416 Prolonged Services Coding Possibilities

The addition of these codes is causing cautious optimism among coders.

“Now here is a set of codes to really sink your teeth into; we hope!” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa. “I am anxious to see how these codes play out in policy and, if reimbursable, what might that reimbursement look like.”

Example: “Often, a physician’s time with the patient only paints a partial picture of what occurred during the visit,” Hauptman says.” For example, staff might give the patient an injection, provide education for a new medication or therapy, or provide guidance or service that goes far past the time associated with the E/M code. Now, CPT® is giving coders a way to recognize that nonphysician work.

“The staff [members] in a physician’s office are important to the care of the patient and also are an expense to the physician,” Hauptman says. “These codes make good sense all around.”

Best bet: Keep an eye on these codes in 2016, in the coding news and in your coding community. Medicare will likely hand down some kind of guidance on 99415/99416, and other payers might follow suit.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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