For 2016, the American Medical Association revised two, existing CPT® codes to describe prolonged evaluation and management (E&M) services by a physician or other qualified health care professional. In addition, the AMA created two new codes to describe prolonged E&M services performed by clinical staff, under the supervision of a qualified provider. Proper documentation and reporting of these codes allows providers to improve compensation for lengthy outpatient services.
For provider services, turn to 99354-99355
The AMA's CPT Changes 2016: An Insider's Guide instructs, "Codes 99354 and 99355 are intended to report prolonged services that are provided by a physician or other qualified health professional."
+99354 Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service)
+99355 … each additional 30 minutes (List separately in addition to code for prolonged service)
Prolonged services 99354 and 99355 must be reported in addition to a primary outpatient (never inpatient) E&M or psychotherapy service, as described by CPT® codes 90837, 99201-99215, 99241-99245, 99324-99337, 99341-99350. The CPT® codebook additionally instructs, "Appropriate codes should be selected for supplies provided or other procedure performed in the care of the patient during this period."
For supervised staff services, call on 99415-99416
In contrast to 99354 and 99355, "Codes 99415 and 99416 are intended to report when prolonged services … are provided by clinical staff," per CPT Changes 2016.
+99415 Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
+99416 …each additional 30 minutes (List separately in addition to code for prolonged service)