AMA CPT® Assistant - 2015 Issue 10 (October)
Evaluation and Management: Prolonged Services (October 2015)
October 2015 pages 3-4 Evaluation and Management: Prolonged Services Revisions and additions were made to the Evaluation and Management/Prolonged Services section of the CPT® 2016 codebook to allow reporting of prolonged monitoring by clinical staff in the office or other outpatient setting that may or may not include face-to-face services by a physician or other qualified health care professional. These changes were the recommendations of an Evaluation and Management (E/M) Workgroup (Workgroup), which was created by the Editorial Panel Chair in answer to a request to identify and report monitoring services provided by nursing staff in an outpatient office...
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Article Overview
This article explains CPT 2016 revisions to prolonged services reporting in evaluation and management. It focuses on the distinction between prolonged clinical staff services and prolonged services with direct patient contact, and summarizes the related guideline updates, timing concepts, supervision context, and reporting framework. The content is relevant to coders, billers, compliance staff, and clinicians working with office, outpatient, hospital, psychotherapy, and nursing facility services.
Why This Topic Matters
The article helps readers understand how CPT reorganized and clarified prolonged services guidance for 2016 so they can better identify the applicable reporting category and related timing considerations.
Article Sections
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October 2015 pages 3-4
Introductory article placement information and the overall topic area covered in this CPT Assistant update.
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Prolonged Clinical Staff Services with Physician or Other Qualified Health Care Professional Supervision
Overview of the revised outpatient prolonged services category for clinical staff and the related supervision context. Includes general guidance and timing framework for the service type.
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General Guidelines for Codes 99415 and 99416
Broad reporting guidance for the clinical staff prolonged services add-on codes, including how time is considered and when the service is separately reportable.
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Coding Tip
A brief note highlighting the relationship between time-based add-on codes and the underlying primary E/M service.
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Prolonged Service With Direct Patient Contact
Revision summary for the prolonged services category involving direct patient contact across office, outpatient, hospital, nursing facility, and psychotherapy settings.
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Coding Tip
A short note clarifying the scope of direct patient contact in the setting addressed by this section.
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Guideline Revisions and Additions for Codes 99354-99357
Expanded guidance for the prolonged direct patient contact code series, including its relationship to primary services and associated timing concepts.
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Coding Tip
A brief reminder that certain supplies and procedures may be reported separately during the service period.
What You Will Learn
- How CPT organized prolonged services guidance for office, outpatient, hospital, nursing facility, and psychotherapy settings
- How the article distinguishes clinical staff prolonged services from physician or qualified health care professional direct patient contact services
- What kinds of guideline updates were made to the prolonged services section for CPT 2016
- What general timing and reporting considerations are discussed for prolonged services
- How the article frames the relationship between prolonged services and the primary E/M or psychotherapy service
Who Should Read This
- Medical coders
- Billing specialists
- Compliance professionals
- Physician practices
- Outpatient clinics
- Hospital coding staff
Codes Discussed
Code Ranges Discussed
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