Neurosurgery Coding Alert

Remember: Time is vital in determining whether to use a prolonged service code.

In the article “3 Handy Tips Shore Up Prolonged Services Coding For Cleaner Claims,” found in Neurosurgery Coding alert Vol. 20, No 8, you learned how to handle when your surgeon provides prolonged services with direct patient contact for a patient beyond the usual evaluation and management (E/M) service time.

Now, learn what to do for cases when your surgeon provides prolonged services without direct patient contact. Read on to learn more.

Report 99358 and +99359 for Prolonged Services Without Direct Patient Contact

Question 1: When can we report the codes for prolonged services without direct patient contact?

Answer 1: You should report prolonged services without direct patient contact when your physician provides a prolonged service that is considered neither face-to-face time in the office or outpatient setting, nor additional unit or floor time in the hospital or nursing facility setting during the same session of the E/M service and is beyond the usual service time. These codes are as follows:

• 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour).
• +99359 (…; each additional 30 minutes (List separately in addition to code for prolonged service)).

Don’t miss: You must report prolonged services without direct patient contact in relation to other physician or qualified health care professional services, which includes E/M services at any level.

You may report prolonged services without direct patient contact on a different date than the primary service to which the prolonged services are related, according to the CPT^® guidelines. However, the prolonged service must “relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management.”

“The prolonged services without patient contact codes must ‘relate’ to a face-to-face service, but do not need to be reported on the same date,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. “In fact, they would often be billed before or after another service to describe time spent preparing for a face-to-face visit (e.g., reviewing old medical records) or to follow up after a face-to-face visit (e.g., reviewing records received after the visit or contacting other providers to coordinate care).”

Calculate Exact Time for Prolonged Services

Question 2: How important is time when reporting prolonged service codes?

Answer 2: Time is vital in determining whether to use a prolonged service code. Don’t miss: You cannot separately report a prolonged service that is less than 30 minutes’ total duration on a given day.

“Assessing when providers are allowed to bill codes 99358 and +99359 is not as easy as it may seem,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. “To begin with, both codes have strictly-defined time components, meaning that the provider must meet over half of the specified time before reporting these codes.”

Report 99358 for the first hour of prolonged service on a given date, regardless of the place of service. Only report 99358 once per date. Report 99358 for the first hour of non-face-to-face services, and it may be billed before or after direct patient care, according to Falbo.

You should report +99359 to represent each additional 30 minutes beyond the first hour of service, no matter the place of service. You can also use this code to report the final 15-30 minutes of prolonged service on a given date. However, you cannot separately report a prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes.

Don’t Report 99358 and +99359 Under These Circumstances

Question 3: What are the rules I must follow when reporting 99358 and +99359?

Answer 3: You must follow specific rules when reporting 99358 and +99359. They are:

• Never report 99358 and +99359 for time spent in care plan oversight services 99339, 99340, 99374-99380; home and outpatient INR monitoring 93792 and 93793; medical team conferences 99366-99368; or on-line medical evaluations 99444.
• Never report 99358 and +99359 during the same month as 99484 and 99487-+99494, according to CPT^®.
• Don’t report 99358 and +99359 when performed during the service time of codes 99495 or 99496.  

Report 99358 and +99359 to represent the total duration of non-face-to-face time the physician spent on the given date providing the prolonged service, but this time on the particular date doesn’t have to be continuous.