Cardiology Coding Alert

Don't Bill Medicare for Prolonged Services Without Direct Patient Contact

Suppose a patient presents with restenosis after angioplasty and a review of multiple previous angiograms is required to determine the most effective course of treatment. Or another physician asks your cardiologist to review a complex patient history.

The CPT provides a set of codes for such occasions that dont involve direct patient contact: 99358 (prolonged evaluation and management service before and/or after direct, face-to-face, patient care, e.g., review of extensive records and tests, communication with other professionals and/or the patient/family; first hour) and 99359 (each additional 30 minutes).

Although cardiologists may be frequent providers of such services, Medicare wont pay for them. Because Medicare has not established relative value units (RVU) for 99358 or 99359, other payers are also reluctant to pay for non-face-to-face time as defined in the CPT: time spent doing work before or after the face-to-face time, such as reviewing records and testings, arranging for further services, and communicating further with other professionals and the patient through written reports and telephone.

Tip: Some managed care companies may pay for non-face-to-face time. Check with your top five payers before billing. As always, make sure you support your claim with thorough documentation.

Note: The American College of Cardiology (ACC) says, With complete documentation, such services might be considered as part of the next face-to-face E/M encounter and a level of service scheduled accordingly. Next means that this non-face-to-face time can be applied toward calculating the intensity of service of the next E/M visit this physician has with this patient, whether it is the next days visit or next month or next years, explains Schnitzer.