Coding for prolonged services was never easy, and CMS’s decision to use HCPCS codes and different time thresholds complicated coding. It is hardly realistic that a physician, nurse practitioner or physician assistant can keep the rules and time thresholds clearly in their head, unless they are the rare practitioner who uses prolonged care frequently. For most practitioners and notes, reporting prolonged care will require that a coder review the note and assign the codes based on the time indicated.

To complicate matters even more, or some prolonged services CMS allows time spent on days before or after the face-to-face service to be included in prolonged care.

We still need to provide education about what needs to be documented.  While neither CMS nor CPT require start and stop times, that doesn’t stop other health insurers from requiring them. Coders need to check their payer websites and include that information in education and guidance.

This guide provides detailed information about coding for prolonged services.

Related resources

• Code Prolonged Services with Confidence | Webinar