decisionhealth Newsletters, Coder Pink Sheets - 2017 Issue 2 (February)
Update rules for new prolonged service codes for smooth sailing this year
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Article Overview
This article explains updated 2017 guidance affecting prolonged evaluation and management services, especially non-face-to-face work billed under CPT and Medicare policy. It is aimed at coders, billers, compliance staff, and providers who need to understand documentation expectations, companion-service relationships, and monthly billing limitations that affect claims processing.
Why This Topic Matters
The update addresses newly available prolonged service reporting, changes in how timing is handled, and several payer-facing restrictions that can affect whether claims are payable. It also highlights documentation and coordination issues that matter to practices billing Medicare-related E/M and care-management services.
Article Sections
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Overview of the 2017 update
Introduces the scope of the 2017 changes affecting prolonged service reporting and related billing guidance. Summarizes the general purpose of the update for practices and claims teams.
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Timing and documentation expectations
Discusses reporting timing for non-face-to-face prolonged services and the need for detailed recordkeeping. Covers the kinds of work and documentation elements emphasized in the guidance.
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Billing restrictions with other monthly services
Reviews service combinations that are restricted under the updated guidance and explains that the limits apply in a specific billing context. Focuses on how prolonged services interact with other monthly reporting categories.
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Companion codes and related service relationships
Describes how prolonged services relate to certain base or companion services and notes additional guidance on bundled or unbundled reporting. Addresses related Medicare policy changes and temporary service considerations.
What You Will Learn
- How the 2017 update affects prolonged service reporting
- What documentation themes are emphasized for non-face-to-face work
- Which related service categories are discussed in the billing restrictions
- How the article frames Medicare and CPT guidance for companion services
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Revenue cycle teams
Codes Discussed
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