Neurology & Pain Management Coding Alert

Question: How should I code a family conference? For instance, a family member who is responsible for the care of this patient at home requests an appointment with the physician to review care, treatment plan, counseling, prognosis, etc. The patient is usually not present.

South Carolina Subscriber

 
Answer: In this case, use the codes for prolonged services without direct face-to-face patient contact (99358-99359). These are time-based codes, reported in addition to other physician services, including E/M services. The physician must precisely document the services rendered, the reason for the services, and all start and stop times.
 
Time billed toward these codes does not have to be continuous, but it must occur on the same date of service. For instance, the physician may counsel the family for 40 minutes, leave to allow the family to discuss the situation, and return 20 minutes later for another 20 minutes of  counseling time. In this case, the total time of the visit is 60 minutes.
 
Report 99358 (prolonged evaluation and management service before and/or after direct [face-to-face] patient care... ) for the first hour and 99359 (... each additional 30 minutes) for services lasting longer than an hour. Prolonged services of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes should not be claimed.
 
For instance, the patient has an evaluation for which the neurologist claims 99214 (office or other outpatient visit for the evaluation and management of an established patient). Following the workup, the family asks to see the physician for advice on caring for the patient at home. The neurologist spends 55 minutes with the family answering questions and providing guidance. The family asks that the physician allow them to consider if they have any other questions and return in 15 minutes. He leaves the room, returns 15 minutes later and spends an additional 22 minutes answering questions, for a total time of 77 minutes. In this case, the physician would report 99358 and 99359 in addition to 99214. If the total time had been 73 minutes, only 99358 and 99214 could have been claimed. For 106 minutes, 99358, 99359 x 2 and 99214 could have been reported.