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Pulmonology Coding Alert

Reader Question:

Bill Direct, Prolonged Patient Contact With 99354

Published on Sun Oct 12, 2003

Question: Will carriers pay our pulmonologist for more than 30 minutes of additional time spent discussing the patient's condition with other healthcare professionals or arranging treatment in the patient's absence?

Florida Subscriber
 
Answer: No. CMS forbids Medicare carriers from reimbursing for conferring with healthcare professionals and arranging treatment in the patient's absence. Also, few private payers reimburse for indirect patient care, either.
 
But CPT offers two codes for prolonged services without face-to-face contact: +99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care [e.g., review of extensive records and tests, communication with other professionals and/or the patient/family; first hour) and +99359 (... each additional 30 minutes). Medicare hasn't assigned relative value units to these add-on codes and instructs Medicare carriers not to reimburse for prolonged services without direct contact between the patient and physician.
 
The Medicare Carriers Manual instructs carriers not to "pay prolonged service codes 99358 and 99359 ..."  Also, the manual states that +99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other
outpatient evaluation and management service]) and +99355 (... each additional 30 minutes [list separately in addition to code for prolonged physician service]) include payment for services without direct contact.

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