Wiki 99358/pharmacist

CICIB

Networker
Messages
34
Best answers
0
Help!

It is appropriate for a Pharmacist to bill for 99358 for the time spent prior patient appointment e.g. reviewing labs, meds, and notes. ?

Thank you!
 
There may be some payers that allow this, but the short answer is no. Pharmacists are not credentialed as providers by Medicare and by most insurance plans so they are not able to bill for services on the physician fee schedule. In order to bill anything, the services would have to meet 'incident to' requirements, which is not the typical type of service that pharmacists are providing. Also, CPT 99358, being a physician service code, requires a face-to-face service by the physician, so is not a code that would be eligible for this.
 
Is it private ins, w/c, or medicare? Also, was the pharmacist working in the docs office or in a pharmacy?

99358 does appear to allow for NPP if medicare. I am still new to coding but here is a link that may help.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/mm5972.pdf

or

https://kb.daisybill.com/articles/cpt-codes-99358-99359-non-face-to-face-services

"CPT Guidelines
99358: May be reported on a different date than the primary service to which is it related. Must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. Does not need to be continuous. Time can not be counted more than once towards the provision 99358 and any other PFS service.


You need to spend at least 31 minutes of time to bill the first hour (99358) of prolonged time."

OR

https://blog.daisybill.com/the-5-point-checklist-for-cpt-codes-99358-and-99359

"In checklist form, the adopted CPT guidelines for reporting codes 99358 and 99359 consists of 5 points:

1. CPT Codes 99358 and 99359 may only be used when a prolonged non-face-to-face service
Is neither:
Face-to-face time with a patient during an evaluation and management service in the office or outpatient (non-facility) setting, nor
Additional time in a facility setting during the same evaluation and management service[1]
AND

Is “beyond the usual” time a provider would spend on a service.
2. Prolonged service is to be reported in relation to other physician or other qualified health care professional services, including evaluation and management services at any level.
3. A provider is allowed to bill for non-face-to-face prolonged service on a different date than the primary service.
4. However, prolonged service must relate to
The past or future direct, face-to-face care of the patient
ongoing patient management
5. The face-to-face primary service CPT code need not have a time requirement."
 
Last edited:
Top