Podiatry Coding & Billing Alert

Hint: Only report 99358 once per date.

In the article “Bust 3 Prolonged Services With Direct Patient Contact Myths” in Podiatry Coding and Billing Alert Vol. 11, No. 8, you learned all about what to do when your podiatrist provides prolonged service for a patient beyond the usual evaluation and management (E/M) service time.

But, did you know that CPT^® also has guidelines devoted to prolonged services without direct patient contact? Read on to learn how to appropriately report these codes.

Tip 1: Rely on Codes 99358 and +99359

You should report codes for prolonged services without direct patient contact when the 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:

• 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, remember 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,” explains 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).”

Tip 2: Time Must be Documented to Report Prolonged Services

Time is a key factor in determining whether to use a prolonged service code. Note, 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,” explains  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.

Tip 3: Heed These Rules When Reporting 99358 and +99359:

Rule 1: You should also 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.

Rule 2: You should never report 99358 and +99359 during the same month as 99484 and 99487-+99494, according to CPT^®.

Rule 3: Never report 99358 and +99359 when performed during the service time of codes 99495 or +99496.

Rule 4: You should 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.

Rule 5: Remember, that per CMS Transmittal 3678, codes 99358 and +99359 can only be used to report extended qualifying time of the billing physician or other practitioner (not clinical staff time), reminds Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, president and CEO of SLG, Inc. Consulting in Raleigh, North Carolina.

Tip 4: Increase Provider Education for Success

Reporting the prolonged service codes, both those without direct patient contact and the prolonged service codes with direct patient contact (+99354-+99357) require provider education because the medical documentation must be excellent, Bucknam says. This documentation must cover the services provided, the amount of time involved, and also the medical necessity for the prolonged services.

Tip 5: Two Different Providers Can Combine Prolonged Services

Both prolonged services codes with and without direct patient contact can be used when two different providers in the same specialty and group provide services that would meet the rules for billing prolonged services, according to Bucknam.

For example, if two different providers round on a patient on the same date, their work can be combined to bill a higher level of service or might qualify, depending upon the documentation, to bill both a subsequent hospital visit and prolonged services, Bucknam says. This requires some coordination between the providers, but it is the only way to get reimbursed for the work that’s actually being done.