Lengthy office visits

February 1, 2008

I occasionally encounter a Spanish-speaking patient who has a complex problem that requires an extensive explanation, and I spend a great deal of time making certain he comprehends what I'm telling him. Can I get compensated for the extra time I spend during these visits?

I occasionally encounter a Spanish-speaking patient who has a complex problem that requires an extensive explanation, and I spend a great deal of time making certain he comprehends what I'm telling him. Can I get compensated for the extra time I spend during these visits?

Probably. If more than 50 percent of the visit was spent in counseling and/or coordination of care, you may choose the level of E&M service based upon time instead of the key components of history, exam, and medical decision-making. For example, if you spent 25 minutes face-to-face with an established patient, and more than half of that time was spent explaining treatment options, you could submit code 99214. Your documentation should include the start and stop times for the visit, as well as the portion of time you spent on the counseling and coordination of care. Also note the content of the discussions.

But if you didn't spend more than half the visit on counseling, and the encounter exceeded the typical time for a particular level of service by at least 30 minutes, it would be appropriate to use the prolonged care codes (99354 or 99355). These codes are add-on codes, so they're reported in addition to the E&M code. For instance, the typical time for a 99215 established-patient visit is 40 minutes. If you spend an additional 35 minutes with the patient, the correct coding would be 99215, and 99354, for the additional 35 minutes. Medical necessity must require the extra time, and the patient's inability to communicate falls within that criteria. Remember to clearly document the reason for the visit.