Wiki 99358

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Blackhorse

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MRI Results

I reviewed the MRI scan and discussed the results with the patient over the phone at her request. She is in a hurry to get things are needed for surgery since she is a teacher at school which starts soon. I discussed the results of the scan which showed a radial tear of the medial meniscus as well as some chondromalacia of the patella. We discussed conservative options which include cortisone injection and physical therapy. Unfortunately she is already on prednisone for sarcoidosis and is unlikely a cortisone injection will result in much more improvement than the prednisone. Additionally, physical therapy will improve strength but not correct the meniscus abnormality. Therefore, surgical management is indicated.

I discussed with the patient at length the potential benefits of surgery as well as the risks and alternatives. The patient understands there may be persistent pain, stiffness, and weakness after surgery. The patient understands the potential failure of surgical management to achieve the outcomes expected. I discussed the pre-and postoperative expectations, associated rehabilitation, and the potential restrictions necessary. I will see the patient back for preoperative history and physical examination once surgery has been scheduled. At this time, given the nature of the patient's condition surgical management is indicated in the form of right knee arthroscopy with partial medial meniscectomy, chondroplasty and possible synovectomy.

I spent a total of 45 minutes of time with this patient of which at least 50% was spent counseling and coordinating care.




Per above document, our doctor used 99358 and got denied by Blue Cross. Anybody knows why?


Thank you.
 
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I was told by Blue Cross that this code cannot be used alone. Should I add this code to the following office visit?

Thank you.
 
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the add-on status to 99358 was removed several years ago. it is now a stand alone code. I am unsure why the rep would indicate otherwise. It is highly likely that is it non payable.
 
Some BCBS policy examples stating not reinbursable. Seems to be the same for all of the Blues

https://www.bluecrossmn.com/healthy...PublicContentServlet?contentId=P11GA_15091624

Blue Cross and Blue Shield of Minnesota (Blue Cross) provides reimbursement for face-to-faceprolonged physician services codes 99354-99357. Use CPT guidelines to report ProlongedServices. Review of tests with the patient only is not considered prolonged care and as such willbe denied.

Codes 99358-99359 are not reimbursed (prolonged services without face-to-face patientcontact) and will deny as provider liability.
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BCBS Idaho

https://providers.bcidaho.com/policies-and-procedures/pap/pap284.page

In accordance with CMS guidelines, Blue Cross of Idaho will not reimburse prolonged services when they do not represent direct (i.e. face-to-face) patient contact (CPT codes 99358-99359).
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Anthem BCBCS

https://www11.anthem.com/shared/noa...534.pdf?refer=ahpculdesac&na=cosecurepolicies

Prolonged Service Without Direct Patient Contact:CPT codes 99358-99359, which describe non-face-to-face services performed before and/or after direct patientcare are not eligible for separate reimbursement. (These codes are also listed in the Bundled Services andSupplies Reimbursement Policy.)
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Its consistent with CMS policy:

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

Finally, you should remember that Medicare contractors will not pay (nor can you billthe patient) for prolonged services codes 99358 and 99359, which do not require any patient face-to-face contact (e.g., telephone calls). These are Medicare coveredservices and payment is included in the payment for other billable services.
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Thank you so much for the research.

However it looks like that WC will pay for it.

Official Medical Fee Schedule – Physician/NonPhysician Services will be updated as of March 1, 2017.


The California Division of Workers’ Compensation (DWC) has released its 2017 update to the Official Medical Fee Schedule (OMFS) – Physician/Nonphysician Services. The changes are effective March 1, 2017. 2017 will be the first year that the OMFS is completely transitioned to Medicare’s RBRVS system and we will be using a single conversion factor except for anesthesia which continues to have its own unique conversion factor.

It is important to note that there are some significant changes potentially affecting orthopaedic practices:
1. Prolonged Service codes – non-face-to-face time – CPT codes 99358 and 99359 have been restored as billable codes. Their Billing Status in the fee schedule has changed to “A” - a billable code. Many orthopaedic practices used these codes to bill non face-to-face time for review of records. Medicare realized that the value of this additional work was not included in the value of the E&M services and they restored providers’ ability to bill these codes and in the update, DWC is following suit. It is important to remember the CPT definition of these codes:
99358 – Prolonged evaluation and management service before and/or after direct patient care, first hour.
99359 – each additional 30 minutes
It is not required that the time be continuous or spent all on the same day, however, prolonged service of less than 30 minutes total duration on a given date is not separately reported. Previously DWC had allowed the billing of these codes in 15 minute increments. Physicians will need to document the time spent in their reports. It is unclear whether DWC will also allow physicians to bill for the report. COA has asked DWC to clarify this point.
2. Physical Therapy Evaluations Codes – 3 new codes for PT evaluations (97161 – low complexity; 97162 moderate complexity; and 97163 high complexity) and 1 new code for reevaluation (97164). Medicare did not adopt tiered payment levels. Here is a link to a summary of the changes to the physical therapy codes prepared by American Physical Therapy Association (APTA): http://www.apta.org/PaymentReform/NewEvalReevalCPTCodes/ Again DWC, has followed Medicare’s lead and adopted these codes as part of the update.

3. Radiology Diagnostic Imaging Multiple Procedures (MPPR) The OMFS is amended to reflect CMS’ revision to the MPPR of the Professional Component of the second and subsequent procedures from 25 percent to 5 percent of the physician fee schedule amount. The MPPR on the Technical Component of imaging remains at 50 percent.

4. Place of Service – A new POS 02 (telehealth is added to confirm to CMA Place of Service Codes.
To learn about these and other updates to the OMFS, we encourage you to sign-up for one of the DaisyBill complimentary webinars which will review these 2017 changes scheduled for February 21 or February 28. To sign-up, go to: https://www.daisybill.com/webinar-registration


Blackhorse, CPC-A
 
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99358 billing help

Does 99358 only apply to Non F2F with the patient or is that family too? Provider wants me to bill 99358 with speaking to patients wife. Is that allowed, since its F2F but with patients wife?

Thank you for the help!
 
PLEASE HELP Does anyone know if these codes require a modifier? they are getting denied.
Any help would be appreciated.
with Florida DWC.

97162
97163
97164
 
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