Internal Medicine Coding Alert

Published on Wed Oct 01, 2003 PDF

Question: Will carriers pay our internist for more than 30 minutes of additional time spent discussing the patient's condition with other healthcare professionals or arranging treatment in the patient's absence?

North Carolina Subscriber

Answer: CMS forbids Medicare carriers from reimbursing for conferring with healthcare professionals and arranging treatment in the patient's absence. Also, few private payers reimburse for these services, either.
 
CPT, however, offers two codes for prolonged services without face-to-face contact: +99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care [e.g., review of extensive records and tests, communication with other professionals and/or the patient/family]; first hour) and +99359 (... each additional 30 minutes).
 
Medicare hasn't assigned relative value units to these add-on codes and instructs Medicare carriers not to reimburse for prolonged services without direct contact between patient and physician. The Medicare Carriers Manual instructs carriers not to "pay prolonged service codes 99358 and 99359 ..." Also, the MCM states that 99354 and 99355 (Prolonged physician service ...) include payment for prolonged services without direct contact.