Prolonged Service without Direct Patient Contact All Staff Meeting Jan 26th Savannah Thompson

Prolonged Service without Direct Patient Contact Codes 99358 and +99359 Time Based Codes Used to report when time spent 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 or other qualified heath care professional service time To be reported in relation to other physician or other qualified health care professional services, including E&M at any level May be reported on a different date than the primary service to which it is related (ex. Extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past record) Must relate to a service or patient where (face-face) patient care has occurred or will occur and relate to ongoing management

CPT Rules This service may be provided on the same day or on a different day than the face- to-face service May be in either the inpatient or outpatient setting Code 99358 is NOT an add-on code, 99359 IS an add-on code to be coded with 99358 The time spent during the service does NOT need to be continuous Can not be reported 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 (care plan oversight:99339, 99340, 99374, 99380: anticoagulant management: 99363, 99364, medical team conferences: 99366-99368, online medical elevations:99444, and other non face-to-face that have specific codes)

99358 – The First Hour Used to report the first hour of prolonged service on a given date regardless of the place of service. (It should be used only once per date) Must spend at least 31 minutes to bill, prolonged service of less than 30 mins total duration on a given date is NOT separately reported Worth 2.10 RVUs and reimburses at $119.56

+99359 each additional 30 mins Used to report each additional 30 mins beyond the first hour regardless of the place of service. Used to report the final 15-30 mins of prolonged service on a given date Prolonged service of less than 15 mins beyond the first hour or less than 15 mins beyond the final 30 mins is not reported separately Worth 1.00 RVUs and reimburses at $57.52

Examples Patient is coming in for a new patient evaluation in the office. The day prior the clinician spends 45 minutes to thoroughly review medical records (a 2 inch thick binder that was delivered to the office), and inputs abstracted data into the EMR. Physician can bill a 99358 for the time spent. The next day the patient comes in for their office visit – the physician bills the appropriate E&M code for the time spent with the patient. Patient is seen in ALF. The care plan is discussed with the family member. The NP bills for her normal E&M visit. The following day the family member calls with questions about the labs that were ordered the previous day. This results in chart review, referral to a specialist, calls to the specialists to give information, call back to the family member to discuss the updated plan of care which takes 80 minutes. The NP can bill 99358 and 99359 for the time spent in ongoing management of the patient’s care.

Questions?