Neurology & Pain Management Coding Alert

Question: Is it appropriate to report prolonged services codes in addition to a telephone evaluation and management service?

Arizona Subscriber

Answer: No, you cannot submit 99354-99357 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service …) with any of the telephone E/M service codes (99441-99443, Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment …). The prolonged services codes require direct face-to-face patient contact, which is not possible with telephone E/M services.

Appropriate choices: CPT^® coding notes outline which procedures you can report with the prolonged services codes. Check this list before submitting your claim to help ensure compliance. The manual includes the following information in the section guidelines for Prolonged Services without Direct Patient Contact: “Codes 99358, 99359 may be reported when related to other non-face-to-face service codes that have a published maximum time, (e.g., telephone services).”