Physician Practice

Q&A: You've got questions! We've got answers!

Physician Practice Insider, July 21, 2017

Q. When using the newly covered non-face-to-face prolonged service codes (99358, 99359), can you bill them with time that has been accumulated over several dates of service? I’m asking because this seems very conceivable from a clinical perspective.

A. In a word — no. Medicare is deferring to the CPT rules and descriptions governing 99358 and 99359, and those rules are clear that you’re not allowed to take time from two or more dates of services and combine those minutes or hours into one lump sum.

“Like any time-based code, it must be a specific date, not a combination of days,” advises Maxine Lewis, president of Medical Coding and Reimbursement in Cincinnati. The CPT book is just as clear: “It should be used only once per date.”

However, that doesn’t mean your prolonged service time must occur on the same date of service as the companion E/M code to which it relates. For example, a physician performs an April 13 office visit then receives and reviews the patient’s medical records April 15. In that scenario, you’re eligible to report the prolonged service codes on a separate date of service than the E/M code.

You’re also eligible to add up non-continuous time to meet the reporting threshold — as long as the time spent reviewing charts or conducting other non-face-to-face work all occurs on the same date of service.

For example, let’s say a provider “reviewed the chart of a trauma patient coming to his service from another hospital in the morning for 30 minutes and then reviewed additional information around noon,” offers Lewis. The total time across two different segments was 50 minutes, or “enough to bill a 99358,” she says.

Also, don’t forget that a Correct Coding Initiative update, effective April 1, caps the total units of add-on code 99359 that you can bill in one date of service at two.

This Q&A originally was published in Medical Practice Coding Pro.

Editor’s note: Email your questions to Editor Karen Long Rayburn at klong@decisionhealth.com.

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