Pediatric Coding Alert

Groaning thinking of all the time you'll never capture for complex cases requiring extensive pre-visit services?

CPT 2010 brings you hope. Guideline revisions "liberalize prolonged non-face-toface services codes," reports Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. "This CPT change is a really good one."

For 2010, you can count indirect prolonged service time that occurs around the date of the E/M service. "Under the old definition, the non-face-to-face service had to be the day of the E/M," Tuck explains.

Be careful: Prolonged service codes 99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; first hour) and +99359 (... each additional 30 minutes [List separately in addition to code for prolonged physician service]) still have to relate to an E/M service that involves face-to-face patient contact. The prolonged service "must relate to a service or patient where direct [face-to-face] patient care has occurred or will occur and relate to ongoing patient management," according to the revised notes. CPT places no timeframe on the time that can elapse between the primary service and prolonged service.

"The loosening of the prolonged non-face-to-face service codes is going to be a great help if you're going to see a complex child," Tuck says. You can look at the patient's chart and make phone calls before seeing the patient and count that time.

Here's a good clinical example from Tuck: "I saw a baby with Down's syndrome with heart failure and home nursing. I spent a lot of time over several days before and after the actual visit, reviewing the patient's chart and making phone calls to coordinate her subspecialty care.

Under the current 2009 non-face-to-face guidelines that were effective at the time of this encounter, I could code only 99205 (Office or other outpatient visit for the evaluation and management of a new patient ... Physicians typically spend 60 minutes face-to-face with the patient and/or family) and 99358 for the first hour of non-face-toface prolonged service that I performed on the same day. I couldn't report the work I had done earlier that week."

In 2010, Tuck could tally each day's non-prolonged service time before and after the encounter and report the applicable time-based code(s). The time is cumulative but does not have to be continuous, according to the revised guidelines. The codes' descriptors remain the same.

Make sure you assign a code(s) for the total prolonged services that occur on each day. "You can't add up prolonged services over a month," cautioned Peter A. Hollmann, MD, AMA CPT editorial panel vice chair in the "Evaluation and Management" session at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago on Nov. 12. Choose 99358 and possibly +99359 based on all the time the physician spends on indirect prolonged services on one day.

You need to spend 30 minutes of time to bill the first hour (99358) and 75 minutes to bill the first hour plus an additional 30 minutes (+99359) of prolonged time. The time needs to be carefully documented and be beyond the time specified in the E/M base code's CPT descriptor, such as 60 minutes for 99205.

Be careful that you don't double-dip on non-face-toface services. "You can't count time twice," warned Hollmann, who is also a medical director for Blue Cross Blue Shield of Rhode Island.

Example: Your office is billing phone calls (99441-99443, Telephone Services) and non-face-to-face prolonged services (99358, and possibly +99359) that a physician provides to a patient. You would not include separately billed phone call time when assigning the prolonged services code(s).