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Prolonged preventive 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 30 minutes (list separately in addition to code for p...

HCPCS code

Name of the Procedure:

Prolonged Preventive Service (G0513)

  • Common Name: Extended Preventive Care Visit
  • Technical Term: Prolonged preventive service(s) beyond the typical service time of the primary procedure

Summary

Prolonged preventive services refer to extended health consultation sessions that go beyond the standard time allocated for preventive care visits. These extended sessions are usually held in an office or outpatient setting and involve direct patient contact.

Purpose

  • Medical Conditions Addressed: Chronic conditions requiring detailed management, complex medical histories, or multiple health concerns.
  • Goals/Expected Outcomes: Thorough assessment and management of the patient’s health, comprehensive preventive care planning, addressing all health concerns in one visit.

Indications

  • Specific Symptoms/Conditions: Complicated medical histories, multiple chronic conditions, or requiring detailed preventive counseling.
  • Patient Criteria: Patients who need more time for thorough discussions, complex cases, or those requiring extensive health education and preventive care planning.

Preparation

  • Pre-procedure Instructions: Bring all current medications, medical records, and a list of health concerns. No special preparations like fasting are usually required.
  • Diagnostic Tests/Assessments: Any ongoing diagnostic results should be brought to the appointment for review.

Procedure Description

  1. Initial Assessment: Conducted by the healthcare provider to review patient history and current health status.
  2. Extended Consultation: Detailed discussion of medical conditions, preventive measures, and treatment plans.
  3. Health Education: In-depth counseling on lifestyle changes, medications, and other preventive strategies.
    • Tools/Equipment: Standard medical examination tools, patient records, and educational materials.
    • Anesthesia/Sedation: Not applicable.

Duration

  • Typical Duration: First additional 30 minutes beyond the usual service time.

Setting

  • Location: Office or other outpatient settings like clinics or health centers.

Personnel

  • Healthcare Professionals: Typically involves a physician or a nurse practitioner, sometimes assisted by a nurse or medical assistant.

Risks and Complications

  • Common Risks: Minimal to none, as it involves only extended consultation.
  • Rare Risks: None specific to the extended consultation; standard risks related to routine visits apply (e.g., minor discomfort during examination).

Benefits

  • Expected Benefits: More comprehensive care, thorough evaluation and management, improved patient understanding, and adherence to preventive measures.
  • Realization of Benefits: Immediate, as the session aims to address and manage health concerns during the visit.

Recovery

  • Post-procedure Care/Instructions: Follow-up on any preventive measures or treatment plans discussed during the visit.
  • Recovery Time: None required; patients can resume normal activities immediately.
  • Follow-up Appointments: As necessary, based on the preventive care plan.

Alternatives

  • Other Treatment Options: Standard-length preventive care visits, telehealth consultations, or referrals to specialists.
  • Pros and Cons: Shorter visits may be less comprehensive but require less time. Telehealth can offer convenience but may lack thorough physical examinations.

Patient Experience

  • During the Procedure: Patients will engage in an in-depth discussion about their health with their provider; they should feel listened to and have the opportunity to ask questions.
  • After the Procedure: Patients may feel more informed and empowered about their health. No pain or discomfort is expected; the experience is similar to a prolonged conversation.

Medical Policies and Guidelines for Prolonged preventive 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 30 minutes (list separately in addition to code for p...

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