Rheumatology Coding Corner Answer: Prolonged Service without Direct Patient Contact, Part 2

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CPT codes

• 99358—prolonged evaluation and management (E/M) service before and/or after patient care; first hour
• 99359—each additional 30 minutes (list separately in addition to codes for prolonged service)

Coding Rationale

No—This scenario would not support the medical necessity to bill the prolonged service code(s). Keep in mind, the time that the supporting staff and provider spent on paper work or on the prior authorization for a patient cannot be combined for CPT codes 99358 and 99359.

CPT codes 99358 and 99359 describe prolonged E/M services that are not face to face with the patient and can occur before or after a face-to-face service and relate to ongoing patient management. But the service must be above and beyond the usual physician or other qualified healthcare professional service time. Although the Centers for Medicare & Medicaid Services are now paying for prolonged services, the Office of Inspector General’s Work Plan for 2017 states these services are considered “rare and unusual.” This implies that providers should provide evidence that they had a definite and compelling reason to bill for prolonged services.

For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at [email protected] or call 404-633-3777 x820.