decisionhealth Newsletters, Answer Books - 2011 Issue 5 (May)
Prolonged Services / Prolonged service codes OK when EM is for counseling
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Article Overview
This premium article reviews Medicare clarification on when prolonged service reporting may apply to evaluation and management visits that are primarily counseling or coordination of care and billed based on time. It is aimed at coders, billers, and compliance staff who need to understand the general framework for pairing prolonged service codes with the appropriate E/M visit level, including use of CMS timing guidance and threshold tables.
Why This Topic Matters
Accurate reporting of prolonged services affects compliant E/M coding and helps practices align documentation and time-based billing with Medicare policy.
What You Will Learn
- How Medicare addresses prolonged services in time-based E/M visits
- How counseling or coordination of care affects prolonged service reporting
- How CMS timing guidance and threshold tables are used at a high level
- What types of E/M visits are discussed in the context of prolonged service billing
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
- Physician office staff
Codes Discussed
Code Ranges Discussed
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