Prolonged Evaluation and Management Services: Documentation Reminders
Recent claim reviews performed by a Comprehensive Error Rate Testing (CERT) contractor have found errors regarding the reporting of prolonged evaluation and management (E/M) services. Prolonged evaluation and management services with direct patient contact are reported when a physician or other qualified health care professional provides prolonged service(s) involving direct patient contact that is provided beyond the usual evaluation and management services service in either the inpatient or outpatient setting. Prolonged evaluation and management services with direct patient contact are reported with CPT codes 99354-99357.
The most common error found by the CERT contractor is the performing physician/non-physician practitioner (NPP) did not submit sufficient documentation to support the services in accordance with Medicare standards.
- The provider must document the start and end times in the medical record
- Only the duration of direct face-to-face contact between the physician and the patient may be counted
- Prolonged physician services require direct face-to-face patient contact one hour beyond the usual service
For more information about Prolonged Services can be found in the CMS Internet-Only Manual, Publication 100-04, Chapter 12, section 30.6.15 - Prolonged Services and Standby Services (Codes 99354-99360).
Questions regarding billing and coding can be sent to ASCO’s Coding and Reimbursement Service.