Wiki Billing 99358

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tanyaneeley

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I started working for a urgent care center a month ago.. They bill 99358 for almost every visit.. If the patient is in the center on IV for over a hour, can they code 99358??? Please help.
 
They assume that since patient is in the clinic for over an hour, that they can bill 99358. When can you bill 99358?? Please help thank you
 
you cannot use 99358 to bill for patient wait time. 99358 is for the provider to charge when the provider spends time on a patient in a non face to face manner such as speaking with family members or extra ordinary chart review. it must be documented by the provider as to what exactly was being done and the amount of time spent on the activity on that patient only. The description includes:
"99358 and 99359 are used when a prolonged service is provided that is neither face to face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an E&M service and is beyond the usual physician time or other qualified health care professional service time"
So when a patient is in the office/clinic setting, that is considered a face to face encounter.
I don't think it is reasonable to think that the provider is documenting relevant non face to face time for every patient encounter that amounts to 30 minutes at minimum.
I think this practice needs further investigation in your setting.
as to your original question, the code for IV administration includes the supervision time spent during the infusion.
 
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Thank you so much for your assistance.. So when can a provider bill 99354??
 
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99354 is when the provider sees a patient and exceeds the time component for a visit by 30 minutes or more. it must be all face to face with the physician and the time must be documented. for instance
a patient presents with asthma with exacerbation.. the physician evaluates the patient and documents the components equal to a 99213 and states he spent 15 minutes with the patient before leaving the room while a tech administers a treatment. ( this must be documented time) then the provider comes back into the room post treatment and again evaluates the patient and documents components that would be equal to a level 2 or 3 and indicates he spent 20 minutes evaluating the patient. at this time the provider leaves the room and then come back in to give prescriptions and instructs the patient on the appropriate use of a rescue inhaler and other instructions.. and states he spent 10 minutes with the patient. so what you have is a total of 45 minutes to perform the components of a 99213. so take the 99213 which is 15 minutes and subtract from 45 and you have the required 30 minute minimum to add on the 99354 so you would bill the 99213 and the 99354. the key is the provider must be face to face with the patient and document the time spent.
in your original question you indicated a patient receiving IVs. You cannot use 99354 to cover IV administration as that is already covered with the IV admin codes. when you use 99354 there cannot be any other billable service during the time you are billing the 99354 for. That is why in my example the provider must document that he left the room prior to the treatment and entered the room after. so for a patient receiving IVs you would need a visit level, then the IV and then after the IV has been discontinued if the provider again sees the patient and the time for the E&M prior to the IV start and the time spent after the IV has been DC'd adds up and you have 30 or more minutes left after the visit level is subtracted you could then bill the E&M the IV and the 99354.
 
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