CMS Now Covers 99358, +99359 Prolonged Services

CMS Now Covers 99358, +99359 Prolonged Services

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. As of Jan. 1, 2017, CMS has made an exception and will now allow Medicare coverage for non face-to-face prolonged service 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), in compliance with CPT® guidelines.

Source: CMS Transmittal 3678, Change Request 9905 (Dec. 16, 2016)

CPT® Evaluation and Management/Prolonged Services instructions dictate:

Codes 99358 and 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 evaluation and management service and is beyond the usual physician or other qualified health care professional service time.

Report Prolonged Services with E/M Codes

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.”

In keeping with CPT® requirements, CMS stresses, “codes 99358 and 99359 cannot be reported during the same service period as complex chronic care management (CCM) services or transitional care management services. They are not reported for time spent in non-face-to-face care described by more specific codes having no upper time limit in the CPT code set.” CMS further stipulates, “99358 and 99359 can only be used to report extended qualifying time of the billing physician or other practitioner (not clinical staff).”

Codes 99358 and 99359 are time-based and include “the total duration of non-face-to-face time spent by a physician or other qualified health care profession on a given date providing prolonged services, even if the time… is not continuous,” according to CPT®. The codes are applied as follows:

Total duration of services      Coding

< 30 minutes                                    Not reported separately

30-74 minutes                                  99358

75-104 minutes                                 99358, 99359

105-134 minutes                               99358, 99359 x 2

Documentation should summarize the necessity and specific content of the prolonged services. See the CPT® codebook for additional guidelines to report prolonged services.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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About Has 480 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

7 Responses to “CMS Now Covers 99358, +99359 Prolonged Services”

  1. Kristina Bennett says:

    Do the Prolonged Service codes require the documentation of “start and stop” times or can the documentation of the overall number of minutes suffice?

  2. Vel says:

    I know the time doesn’t have to be continuous, however does it have to be done all in one day or can it be accumulative throughout several days?

  3. Ruth Muench says:

    I’ve missed the Coding knowledge that John V highlights. Welcome back! These codes will be helpful for home bound situations, especially when information wasn’t shared at an office visit. lso can be helpful for people with driving restrictions due to eyesight problems. It can take all day when scheduling free transportation for a 25-30 min office visit. Family member told me about this. Blind in one eye and used cane to walk. She got a tour of the whole city while various stops were made to pick up and drop off others for patient office visits. Thanks to John for Highlighting these codes and Congrats to CMS for their insight.

  4. Essie says:

    Hello,
    Does any one know how documentation must be done by the provider. For example if the Dr. spent 30 minutes later that day speaking to other Doctors regarding the patients condition after the patient was checked out for referring purposes. How will he document that in the progress notes?

    Thanks

  5. Christinne Harris says:

    My providers would like to know if these codes are supposed to be billed on the same date that they are done OR bill out on the day of the e&m visit? My thoughts would be that they bill on the day the prolonged work was done, but I have search and cannot find the answer. They are concerned about whether they are supposed to open another encounter from the associated visit. Please let me know if you can.

  6. Renee says:

    Did you get a response?

  7. munendra kumar says:

    As above mentioned that 99358 and 99359 are reprorted in addition to other E/M services but 99358 is not an add on code, so why it will code in addition to other E/M services. 99358 can bill separately.

    Thanks

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