Neurology & Pain Management Coding Alert

Question: When billing Medicare, should I list 99359 separately for each unit, with modifier -51 appended?

Missouri Subscriber

Answer: Code 99359 (prolonged evaluation and management service ... each additional 30 minutes [list separately in addition to code for prolonged physician service) is an add-on code for use with 99358 (... first hour [list separately in addition to code[s] for other physician service[s] and/or inpatient or outpatient evaluation and management service]). Use this code to report each additional 30 minutes of prolonged services provided beyond the first hour. As an add-on code, it is modifier -51 (multiple procedures) exempt.
 
For example, for 30-74 minutes of prolonged services, report 99358. For 75-104 minutes of prolonged services, use 99358 and 99359. For 105-134 minutes of prolonged services, use 99358 and 99359 x 2, and so on. Prolonged services of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes are not separately reportable. Documentation must clearly record the physician time involved. This must be face-to-face time, but need not be continuous.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandreop, OTR, CPC, CCS-P, CPC-H, consultant-owner and trainer for A+ Medical Management and Education in Egg Harbor City, N.J.