March 1, 2008

How to Code for Extra-long Subsequent Hospital Visits

Let’s say your partner saw a patient in the hospital and billed using one of the current procedural terminology (CPT) codes for an initial consultation, 99251 through 99255. A few days later you see the same patient, who has developed significant complications and requires more than 30 minutes of additional bedside time.  How do you account for the work of your extra-long follow-up visit?  Must you use subsequent hospital care CPT codes (99231 through 99233) or can you use another consultation code?  What about the prolonged services add-on CPT codes (99356-99357)?

According to Larry Martinelli, MD, FIDSA, chair of IDSA’s Clinical Affairs Committee, even though the patient has developed new and significant complications, your work is considered subsequent hospital care and is most likely covered under the subsequent hospital care CPT codes (99231 through 99233). Dr. Martinelli said only under rare circumstances might billing for a new consult be allowed. “If the request is for a new problem and some time has passed since anyone from the group has seen the patient and a new consult request is written for the new problem, then maybe it is okay to bill a new consult,” he said.
However, you can bill prolonged-service CPT codes (99356 through 99357) in conjunction with subsequent hospital care CPT codes (99231 through 99233) if you are engaged in an additional 30 minutes of direct (face-to-face) contact with a patient.  Use CPT code 99356 to report prolonged services of 30 to 74 minutes.  Use CPT code 99357 to report each additional 30 minutes of prolonged service time.  Since prolonged services are add-on codes, modifiers are not needed.

For more information about billing and coding or other practice management issues, IDSA members and their practice managers are invited to join the Practice Management listserve at

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