Academy of Chiropractic’s
Lawyers PI Program 262
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
"Billing Prolonged Services Without Patient Contact "
Disclaimer: This consultation is not designed to tell you when to bill for 99358-99359, nor is it suggested you do. This consultation is limited to teaching you how to compliantly use this code. The use of this code is solely your clinical decision, based upon the necessity of the services in your practice and the needs of your patients.
Over the last few months I have been getting queries on how to properly bill for services on reviewing records, reviewing MRI's and/or coordinating care without direct patient contact. CPT code 99358-99359 accomplished that and this consultation is designed to teach you the parameters of that code so that you can compliantly bill, when clinically indicated as determined by you.
99358: Prolonged evaluation and management service before and/or after direct patient care; first hour
99359: Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (List separately in addition to code for prolonged service)
Prolonged Services Indirect Contact
- Prolonged services performed in a day that are not continuous
- Services provided by the physician or other qualified health care professional in relation to patient management where face-to-face services have or will occur on a different date
- Time spent after direct face-to-face contact beyond the usual not necessarily on the same date of service.
- Any additional unit or floor time in the hospital or nursing facility during the same evaluation and management session
- Care plan oversight
- On-line medical services
- Other indirect services that have a more specific code and no upper time limit in the code
- Time spent in medical team conference
- Code also evaluation and management or other services provided
- Code also non-face-to-face service codes that have an upper time limit
- Code also the code for each additional service for the last 15-30 minutes.
- Do not report services less than 15 minutes beyond the first hour
- Do not report services less than 30 minutes
A 65-year-old new patient with multiple problems is seen and evaluated. After the visit, the physician requires extensive time to talk with the patient's daughter, to review complex, detailed medical records transferred from previous physicians and to complete a comprehensive treatment plan This plan also requires the physician to personally initiate and coordinate the care plan with a local home health agency and a dietician. (Family Medicine/Internal Medicine)
Codes 99358 and 99359 are used when a prolonged service is provided that is neither face-to face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service and is beyond the usual physician or other qualified health care professional service time.
|This service is to be reported in relation to other physician or other qualified health care professional services, including evaluation and management services at any level. This prolonged service may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past records. However, it must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. A typical time for the primary service need not be established within the CPT code set.|
|Codes 99358 and 99359 are used to report the total duration of non-face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service, even if the time spent by the physician or other qualified health care professional on that date is not continuous. Code 99358 is used to report the first hour of prolonged service on a given date regardless of the place of service. It should be used only once per date.|
|Prolonged service of less than 30 minutes total duration on a given date is not separately reported.|
|Code 99359 is used to report each additional 30 minutes beyond the first hour regardless of the place of service. It may also be used to report the final 15 to 30 minutes of prolonged service on a given date.|
|Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.|
|Do not report 99358-99359 for time spent in medical team conferences, on-line medical evaluations, care plan oversight services, anticoagulation management, or other non-face-to-face services that have more specific codes and no upper time limit in the CPT code set. Codes 99358-99359 may be reported when related to other non-face-to-face services codes that have a published maximum time (eg, telephone services).|
The non–face-to-face prolonged service codes without direct patient contact are 99358 and 99359. CPT defines codes 99358 and 99359 as used when “a physician provides prolonged service not involving direct (face-to-face) care that is beyond the usual non–face-to-face component of physician service time.” These codes are to be reported in relation to other E/M services at any level, but may be reported for a different date of service than that of the primary E/M service that they are related to. For instance, if a physician spends an hour extensively reviewing a new patient’s medical records prior to their office visit, the time spent would be documented and included in the patient’s medical record during their scheduled visit. CPT codes 992XX and 99358 would be billed. For each additional 30 minutes over the first initial hour of the prolonged service, CPT code +99359 should be used. Note that 99359 is an add-on code and cannot be billed separately without 99358.
Keep in mind that Medicare will typically not reimburse for prolonged services—both face to face and non–face to face—but some private carriers do; therefore, verify insurance policies regarding these services.
I have previously suggested that you utilize a recognized service for setting your fees. Medicode publishes "Medical Fees in the United States" and others have published what appropriate fees are.
A good place to start is:
Marty Kotlar from Target Coding has a proprietary document on codes he reserves for his clients, but you have to be one of his subscribed clients and it is not a published text, which concerns me in a legal forum.
I am working with 1 other publisher to get what is needed specific for chiropractic and I will forward it to you as soon as it becomes available.