Prolonged Services in medical billing and coding

We will get confuse for Prolonged coding.

While going to code Prolonged service, We must receive documentation from the provider by mentioning of Duration.
 
Duration is very important to code Prolonged service. Prolonged codes are 99354,99355 (Out Patient) and 99356,99357(Inpatient).

When ever find that duration in the Medical Record.  We need to calculate Time and Which Prolonged codes need to add.

Rules:

Duration :

• 30 Minutes we can go with E/M only
• 30 minutes and<74 99354="" 99356="" and="" can="" code="" in="" li="" minutes="" nbsp="" out="" pt="" visit="" we=""> 
• 75 minutes and<104 99354="" 99355="" 99356="" amp="" and="" can="" code="" li="" minutes="" we=""> 
• 105 minutes 99354*1& 99355*2

After Duration of the E/M, We can code Prolonged Services

Eg: A endocrinologist confirms a est patient that a lesion, biopsied a few days before, is malignant. the provider spends 110 min checking non-surgical and surgical methods with the patient. That visit considered as counseling and coordination of care. To charge this visit depended on duration.

 According E/M guidelines level is going to high as 99215.

According to Duration table; 99215 had taken 40 minutes but total visit duration 110 minutes.

Medical Coding Questions for CPC

 

1) What term could describe an inflammation of the plantar, causing foot or heel pain when walking or running?

a) Plantar fascistic  b) Tendonitis c) Tenolysis d) Tendon fascitis                                                          Ans: A

2) Blephroplasty describes what type of a procedure?

a) Surgical reduction of the upper/lower eyelids to remove excess fat, skin, and muscle

b) Treatment for spider veins with injections of sclerosing solution

c) Replacement of damaged skin with healthy tissue taken from a donor

d) Destruction of tissue by burning or freezing                                                                                    Ans: A

3) Which autoimmune disorder will eventually destroy the thyroid gland?

a) Hayem-Farber disease  b)Alzheimer’s thyroiditis

c)Lou Gehrig’s disease d) Hashimoto’s thyroiditis                                                                              Ans : D

4) Which of the following statements best describes a rheumatologist?

a) A specialist who provides medical care and drug treatments focused on mental and cognitive disorders.

b) A specialist who provides treatment to women during pregnancy, childbirth, and their aftercare

c) A specialist who provides the diagnosis and treatment of disease characterized by inflammation of the connective tissues.

d) A specialist who provides the diagnosis and surgical treatment of bone disorders                             Ans: D

5) A patient suffered a burn that involved the epidermis, dermis, and subcutaneous layers with some muscle involvement. What degree of burn would describe this injury?

a) First-degree, superficial with blisters

b) Second-degree, partial thickness with muscle

c) Third-degree, full thickness

d) None of the above                                                                                                                       Ans : C

6) In which part of the body would you find the choroid?

a) Brain  b) Eyeball  c)Muscles of the hand d) Spinal column                                                              Ans:  B

7) Which combining form refers to the small intestine?

a) enter/o  b) gastr/o c) celi/o  d) col/o                                                                                              Ans : A

7). An ERG is what type of a procedure?

a)  Electroretinography   b) Electrorenalography

c) Electroretinograph  d) Electrorhidogram                                                                                        Ans: A                                                                               

8) Which term refers to the anus, rectum, and the cecum?

a) rectal  b) anorectal c)esophageal d) ilium                                                                                        Ans: B

9). Which term does not refer to a level of consciousness?

a) Syncope b)Stupor c)Coma  d) Sciatica                                                                                           Ans: D

10) What type of condition describes a patient diagnosed with oligospermia?

a) Knots is the varicose veins

b) An inflammation of the prostate gland

c) An abnormally low number of sperm in the semen

d) Failure to ovulate                                                                                                                         Ans: C

G0108 and G0109

Medicare provides advantage of diabetes self-management training (DSMT) casework for beneficiaries who accept been afresh diagnosed with diabetes, bent to be at accident for complications from diabetes, or were ahead diagnosed with diabetes afore affair Medicare accommodation requirements and accept back become acceptable for advantage beneath the Medicare Program

A able DSMT affairs includes the afterward services:

 Instructions in self-monitoring of blood glucose,

 Education about diet and exercise,

 An insulin analysis plan developed accurately for insulin abased patients, and

 Motivation for patients to use the abilities for self-management.

DSMT casework are aimed against individuals with Medicare who accept afresh been impacted in any of the afterward situations by diabetes:

Problems authoritative claret sugar,

Beginning diabetes medication, or switching from articulate diabetes medication to insulin,

Diagnosed with eye ache accompanying to diabetes,

Lack of activity in anxiety or added bottom problems such as ulcers or deformities, or an amputation hasbeen performed,

Treated in an emergency allowance or accept backward brief in a hospital because of diabetes, or

Diagnosed with branch ache accompanying to diabetes.``

Coverage Information

Medicare provides advantage of DSMT casework alone if the alleviative physician or alleviative qualifiednon-physician practitioner managing the beneficiary’s diabetic action certifies that DSMT casework are needed. The apropos physician or able non-physician practitioner charge advance a plan of affliction in the beneficiary’s medical almanac and affidavit substantiating the charge for training on an alone base back accumulation training is about covered, if ordered. The adjustment charge additionally accommodate a account active by the physician or able non-physician practitioner that the account is bare as able-bodied as thefollowing information:

The cardinal of antecedent or after effect hours ordered

The capacity to be covered in training , and

A assurance if the almsman should accept alone or accumulation training.

Procedure Codes and Descriptors

The afterward Healthcare Common Procedure Coding System  codes listed are acclimated to address DSMT services

G0108 - Diabetes outpatient self-management training services, individual, per 30 minutes

G0109 - Diabetes outpatient self-management training services, accumulation affair , per 30 minutes

H - Modifier

H9 COURT ORDERED

HA CHILD/ADOLESCENT PROGRAM

HB ADULT PROGRAM, NON GERIATRIC

HC ADULT PROGRAM, GERIATRIC

HD PREGNANT/PARENTING WOMEN'S PROGRAM

HE MENTAL HEALTH PROGRAM

HF SUBSTANCE ABUSE PROGRAM

HG OPIOID ADDICTION TREATMENT PROGRAM

HH INTEGRATED MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM

HI INTEGRATED MENTAL HEALTH AND MENTAL RETARDATION/DEVELOPMENTAL DISABILITIES

HJ EMPLOYEE ASSISTANCE PROGRAM

HK SPECIALIZED MENTAL HEALTH PROGRAMS FOR HIGH-RISK POPULATIONS

HL INTERN

HM LESS THAN BACHELOR DEGREE LEVEL

HN BACHELORS DEGREE LEVEL

HO MASTERS DEGREE LEVEL

HP DOCTORAL LEVEL

HQ GROUP SETTING

HR FAMILY/COUPLE WITH CLIENT PRESENT

HS FAMILY/COUPLE WITHOUT CLIENT PRESENT

HT MULTI DISCIPLINARY TEAM

HU FUNDED BY CHILD WELFARE AGENCY

HV FUNDED STATE ADDICTIONS AGENCY

HW FUNDED BY STATE MENTAL HEALTH AGENCY

HX FUNDED BY COUNTY/LOCAL AGENCY

HY FUNDED BY JUVENILE JUSTICE AGENCY

HZ FUNDED BY CRIMINAL JUSTICE AGENCY

Spirometry Reimbursement Guidelines

94010 - Spirometry  including calculation of the FVC, FEVI, and
optionally ow rate measurements. A graphic record as well as an interpretation must be included

94060 Bronchospasm Evaluation - Spirometry as in 94010 above before and after administration of a bronchodilator 

95070 Inhalation Challenge Testing with histamine, methacholine or similar bronchoprovocation agent

94070 Functional Residual Capacity Multiple spirometric determinations after bronchodilator with spirometry as in 94010

94150 Vital Capacity - Spirometry, Slow Vital Capacity

94200 Maximum Voluntary Ventilation - Maximum breathing capacity, maximum volume ventilation

94375 Flow Volume Loop - Respiratory ow volume loop

94664 Bronchodilator Administration - Aerosol or vapor inhalation.


ICD-9 Codes for Spirometry : 

466 - 466.19     Acute bronchitis and bronchiolitis
490                 Bronchitis, not specified

491 – 491.9      Bronchitis Chronic

492 – 492.8      Emphysema

493 – 493.91    Asthma 
494                 Bronchitis


496                  Chronic airway obstruction, not elsewhere classified

508 – 508.9      Respiratory condition due to other and unspecified external agents
518.9               Other diseases of respiratory system
519.1               Bronchospasm
780.51             Insomnia with sleep apnea 
786.2               Cough
780.53              Hyperinsomnia with sleep apnea
793.1              Abnormal chest x-ray
786                 Abnormal chest sounds
277                 Cystic Fibrosis 
790.7              Chronic fatigue  
787                Heartburn 

E942.9           Other unspecified agents primarily affecting the cardiovascular system
305.1             History of tobacco abuse

V13.8             History of thyroid disorder