# Non face-to-face encounter 99358?



## cyarberry (Feb 27, 2013)

Could someone tell me the correct CPT code to use when physician spends about 40 minutes with the father of of a 16 year-old patient? Physician last examined the patient about 26 days ago but father came in to discuss ongoing problems.


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## sullivak (Mar 1, 2013)

Well, on the surface, it appears you can code 99358 in this case.  Per 2013 CPT, "This prolonged service may be reported on a different date than the primary service to which it is related."  

However, according to the E&M Service Guidelines section of CPT, in the office setting face-to-face "is defined as only that time spent face-to-face with the patient *and/or* family." This, unfortunately, implies that you would need to use the Prolonged Service With Direct Patient Contact codes (99354-99355). However, those codes can only be reported on the same date as the original E/M.  

It looks like this scenario cannot be coded.  Anyone else have thoughts on this?

That's a tough case!


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## nyyankees (Mar 4, 2013)

*Hmmmm*



sullivak said:


> Well, on the surface, it appears you can code 99358 in this case.  Per 2013 CPT, "This prolonged service may be reported on a different date than the primary service to which it is related."
> 
> However, according to the E&M Service Guidelines section of CPT, in the office setting face-to-face "is defined as only that time spent face-to-face with the patient *and/or* family." This, unfortunately, implies that you would need to use the Prolonged Service With Direct Patient Contact codes (99354-99355). However, those codes can only be reported on the same date as the original E/M.
> 
> ...



Does counseling & coordination of care come into play?


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## lec1408@msn.com (Mar 6, 2013)

*lcampbell*

99215 states "40 min spent face-to-face w/ patient "and/or" family. As long as  the components of patient hx and MDM are met, would this code be appropriate?


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## lec1408@msn.com (Mar 6, 2013)

*lcampbell*

...but was the discussion face-to-face or via phone? If via phone, wouldn't 9943 be appropriate?


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## sullivak (Mar 6, 2013)

It would not be appropriate to code 99215 for the physician's speaking with a family member. This does not constitute another patient visit. The actual office visit was on a different DOS.
Regarding counseling and coordination of care - I can see the precedent in using counseling and coordination of care to allow the 99358.  It's disappointing that this specific issue was not addressed in CPT Assistant.


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## cyarberry (Mar 11, 2013)

I really appreciate your input on this one. 

Thank you


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