WASHINGTON, DC (Managed Care Wire): Previously, physicians could not bill prolonged service codes for the lengthy E/M services that they performed in nursing facilities. But CMS now confirms that providers can collect for those prolonged services when they spend additional time with a nursing facility patient.

History: When physicians want to report prolonged services, they look to CPT to determine the typical time that a service should take. Without that benchmark, they can't know how much time a "prolonged" service should take.

But in 2006, CPT removed references to the typical time that practitioners should spend performing E/M services in nursing facilities, therefore no longer allowing these providers to report prolonged services or time-based counseling and coordination of care visits. CPT 2008 included new time guidelines that cover the codes in these categories, but CMS remained mum on whether Medicare would honor them.

CMS issued Transmittal 1489 on April 11 to clarify this issue, which states, "Medically necessary prolonged services for E/M visits [codes 99356 and 99357] in a SNF [skilled nursing facility] or NF [nursing facility] may be billed with the nursing facility services in the code ranges 99304-99310 and 99318." Physicians can use the typical times noted in CPT as a reference.

To view Transmittal 1489, visit www.cms.hhs.gov/Transmittals/downloads/R1489CP.pdf.