Prolonged services are an excellent option to be reimbursed for additional physician time beyond the upper time limits of the visit, with or without direct patient contact, on the same day as the face-to-face visit. There is a code for outpatient (99417) and for inpatient (99418) but only outpatient is discussed here.
99417 can be coded when the additional time is at least 15 minutes above the upper time limit for that billing level (which must also be billed based on time). It can be billed for each additional 15 minutes of time that exceeds the upper time limit for that billing level (you bill in 15-minute increments above the upper time limit for that visit level). For instance, for an established office visit, recall that a 99215 ranges from 40-54 minutes. Thus, if you spend 69 minutes (15 minutes above 54 minutes) caring for an established patient on the day of their face-to-face visit (including pre-charting, seeing the patient, documenting your note after the visit is finished, and all other care for that patient on the same day), you code 99215 and 99417. Additional 99417 codes can be placed for additional 15 minute increments beyond this. Thus, if you had spent a total of 84 minutes caring for that same patient, you would bill 99215 and 99417 x 2 (twice). When billing prolonged care on the day of a face-to-face visit, you can still additionally use the add-on code G2211 (see below).
Similarly, 99417 can also be used for prolonged home visits when spending at least 15 minutes more than the specified upper time limit of 75 minutes for a new patient (along with 99345) and 60 minutes for an established patient (along with 99350). It can also be used for assessment and care planning for patients with cognitive impairment (99483) when time exceeds 50 minutes.
● One exception to billing prolonged home and residence services: Medicare requires you to code G0318, along with 99345 for new patients (requires total time >140 minutes) or along with 99350 for established patients (requires total time >110 minutes). However, these Medicare time requirements are not limited to the date of encounter and can include any work done three days before the date of service and up to seven days after the date of service.
In all cases, time must be carefully documented and the reasons for additional time being needed in order to justify the code and in case of auditing.