decisionhealth Newsletters, Coder Pink Sheets - 2021 Issue 2 (February)
With HCPCS debut, take note of new rules for prolonged services
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Article Overview
This article covers CMS changes affecting prolonged services reported with office/outpatient evaluation and management visits. It is aimed at coding professionals and billing staff who need to understand how Medicare is handling prolonged service reporting, what time-based visit categories are affected, and how the new HCPCS guidance fits alongside existing CPT prolonged service codes. The article also notes payer variability and the broader policy context behind the update.
Why This Topic Matters
These changes affect how prolonged time is reported for office/outpatient E/M visits and may influence claim submission, payer acceptance, and workflow for time-based coding in Medicare and other settings.
Article Sections
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Prolonged services and time-based office visits
Introduces the policy issue surrounding prolonged service reporting with office/outpatient E/M visits coded by time. It discusses how CMS is addressing the relationship between time-based office visit reporting and prolonged service add-on coding.
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HCPCS add-on code guidance and timing table
Summarizes the new HCPCS guidance for Medicare and the associated time-based framework. It also notes payer variability and the operational implications of the updated reporting approach.
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99358-99359 curtailed
Addresses CMS’s position on non-face-to-face prolonged service reporting in connection with office visits. It also describes the broader policy statement CMS gave about future prolonged service coding.
What You Will Learn
- How CMS is changing prolonged service reporting for office/outpatient E/M visits
- Which parts of time-based office visit coding are affected by the new HCPCS guidance
- How payer policies may differ from Medicare on prolonged service reporting
- What CMS said about non-face-to-face prolonged service codes in this context
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance teams
- Practice managers
Codes Discussed
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