General Surgery Coding Alert

Limit billed time to 2 hours.

If you started taking advantage of billing your surgeon’s non-face-to-face work since CMS paved a path for doing so effective Jan. 1, get ready to roll back that practice.

Backstory: In the 2017 Medicare Physician Fee Schedule (MPFS) final rule, CMS pledged separate payments for some E/M services that fell under CPT^® codes 99358(Prolonged evaluation and management service before and/or after direct patient care; first hour) and +99359 (… each additional 30 minutes [List separately in addition to code for prolonged service]) for non-face-to-face physician work to evaluate a patient case “behind the scenes.” You read about this change in “Grab This Opportunity for Non-Face-to-Face Pay” in General Surgery Coding Alert Vol. 19 No. 3

Change: Now, CMS has issued a medically unlikely edit (MUE) for these two codes that went into effect on April 1, 2017. Here’s the gist of the MUE: You will only be able to claim two units of the add-on code +99359 per day, suggests MLN Matters release MM 5972. Since you add +99359 onto 99358 after the first hour, that only allows for a maximum of two hours of reportable time on your claim.

“Documentation is required to be in the medical record about the duration and content of the medically necessary evaluation and management service and prolonged services that you bill,” MLN Matters reminds. These new CMS time thresholds aim to hold providers accountable to the medical necessity of the prolonged care, suggests the guidance.

To read MLN Matters release MM 5972, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5972.pdf.