Wiki Non Direct Prolonged Services

[gena379]

For non direct prolonged services: can you add up times from different dates to reach your 30-74 minutes for 99358 ?

Example:

10 minutes on records review on 5/10/18
10 mins on 5/11/18
15 mins on 5/12

Total 35 Minutes records review = 99358


I am pretty sure NOT and that it has to be on the same day. I know the time doesnt have to be constant on that date of service and you can add it if it's all on the same date but I dont think you can add up times from different dates. My provider says you can... thoughts?

thanks,

 

[Evelyn Kim]

The guidelines in the CPT book state that code 99358 & 99359 are used to report he total duration of non-face-to-face time.....on a given dateeven though the time does not need to be continuous. The description states " Prolonged evaluation and management service before and /or after direct patient care.This leads to the question did the provider have direct contact with the patient on all three days?

 

[TTcpc]

The guidelines in the CPT book state that code 99358 & 99359 are used to report he total duration of non-face-to-face time.....on a given dateeven though the time does not need to be continuous. The description states " Prolonged evaluation and management service before and /or after direct patient care.This leads to the question did the provider have direct contact with the patient on all three days?

Hi Evelyn,

I've been researching prolonged services without direct patient contact lately for a project and have found several sources that state the prolonged time does not have to be necessarily the same day of, but related to a recent E/M. However, everything I'm seeing does state that the combined time is per a given date. So in my opinion the provider would not have needed to have an E/M or direct contact on all three days, but would have had to meet the time requirements for the non-direct prolonged services on each day.

Here's Novitas (our local MAC):
Prolonged Services without Direct Face-to-Face Patient Contact
Codes 99358-99359 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 and is beyond the usual physician or other qualified health care professional service time.
Report these codes in relation to other physician or other qualified health care professional services, including E/M at any level. These may be reported on a different date than the primary service to which it is related.

John even references in an AAPC Knowledge Center article from 2/27/17 that "Codes 99358 and 99359 are to be reported in addition to other E/M service codes, to which they relate. “For example,” CPT® explains, “extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past records.”

 

[PattyB15]

My understanding of the non-face-to-face 99358-99359 is that this code can be billed on a day when no other service is provided. It is not a add on code (99358). To bill this, it must relate to a service for a patient where direct face-to-face has occurred or WILL occur and will be ongoing patient management. If physician spends at lease 31 min reviewing records (doesn't have to be continuous that day) but does have to be on same day.... then 99358 can be charged prior to patient visit on another day.