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Explore This IssueSeptember 2017
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99358 and 99359
The Centers for Medicare & Medicaid Services (CMS) typically does not allow separate payment for physician services that do not require face-to-face time with a patient, but as of Jan. 1, 2017, the CMS added coverage for non-face-to-face prolonged service CPT codes 99358 Prolonged evaluation and management service before and/or after direct patient care; first hour and +99359 … each additional 30 minutes (list separately in addition to code for prolonged service).
The codes in this series are used to report the provision of a prolonged physician service without direct, face-to-face, patient contact that is beyond the usual service (e.g., beyond the typical time) in either the inpatient or outpatient setting.
The first hour of a prolonged service without direct contact on a given date, regardless of the place of service, is reported with code 99358. It should be reported only once per patient, per date, even if the time spent by the physician is not continuous on that date.
Each additional 30 minutes beyond the first hour of prolonged physician service, regardless of the place of service, may be reported with code 99359. This code may also be used to report the final 15–30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not separately reported.
Key CPT Rules for Prolonged Care, Non-Face to Face
- This service may be provided on the same or a different day than the face-to-face service.
- It is for extensive time in addition to seeing the patient and must relate to a service for a patient in which direct face-to-face patient care has occurred or will occur and be part of ongoing patient management.
- Code 99358 is not an add-on code. This means it can be reported on a day when no other service is provided.
- Code 99359 is an add-on to code 99358.
- The time during the day a non-face-to-face service occurs does not need to be continuous.
- The CPT tells us not to report these services during the same month as complex chronic care management (99487, 99489) or during the service time of transitional care management (99495, 99496).
- You cannot double count the time for these non-face-to-face prolonged service codes and time spent in certain other activities represented by specific CPT codes. However, the CPT codes are mostly those that have a status either not covered or bundled by Medicare. (Care plan oversight: 99339, 99340, 99374–99380; anti-coagulant management: 99363, 99364; medical team conferences: 99366–99368; online medical evaluations: 99444; or other non-face-to-face services that have more specific codes and no upper limit in the CPT codes.)
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at firstname.lastname@example.org or call 404-633-3777 x820.