ED Coding & Reimbursement Alert - 2017 Issue 3
Prolonged Services: Grab This Opportunity for Non-Face-to-Face Pay
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Article Overview
This article covers a CMS payment change that affects prolonged, non-face-to-face services tied to E/M work, with emphasis on documentation, timing, and when related prolonged service categories may or may not apply. It is aimed at coders, billers, and physician practices—especially surgical and complex-care settings—who need to understand the scope of the policy update and the related guidance discussed in the article.
Why This Topic Matters
The topic matters because it addresses how certain extended, non-face-to-face physician work may be recognized under Medicare when properly documented. Readers can use the article to assess whether their workflows, record review, and care-management activities fall within the discussed guidance.
Article Sections
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Discover New Life for Old Codes
Introduces the Medicare policy update and the prolonged service categories discussed in connection with non-face-to-face work. Also frames the discussion around broader use in complex and chronic-care cases.
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Watch Documentation and Details
Reviews the article’s general cautions about setting, timing, related E/M services, and documentation. It also contrasts the non-face-to-face prolonged service category with other prolonged service categories referenced in the discussion.
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Understand The Importance of Time
Summarizes the article’s focus on how time is considered for reporting prolonged services and the need to support medical necessity. The section also discusses how the article describes time-based reporting limits and safeguards against overlap with other reimbursable services.
What You Will Learn
- How the article characterizes a Medicare payment update for prolonged services
- What documentation themes are emphasized for extended non-face-to-face work
- How the article differentiates among prolonged service categories by setting and type of contact
- Why time tracking and medical necessity are highlighted in the guidance
- What kinds of practices may find the discussion relevant
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- General surgeons
- Specialty practices managing complex cases
Codes Discussed
Code Ranges Discussed
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