Cardiology Coding Alert

Don't miss out on payment for prolonged E/M codes 99358 and +99359.

CMS has published the Medicare Physician Fee Schedule (MPFS) Final Rule for 2017.

The Final Rule lists an expected 0 percent impact on allowed charges for cardiology.

The conversion factor sees a small increase:

• 2016: 35.8043
• 2017: 35.8887.

Remember: Multiplying a code's RVUs by the conversion factor gives you Medicare's national payment rate for a code. After taking into account geographic location, Medicare determines the final reimbursement amount.

Prolonged services: Be sure to catch that Medicare will provide separate payment for these codes in 2017:

• 99358, Prolonged evaluation and management service before and/or after direct patient care; first hour
• +99359, ... each additional 30 minutes (List separately in addition to code for prolonged service).

In 2016, the status for theses codes was B, meaning bundled into payment for other services. Here are a few takeaways from the MPFS discussion of these codes:

• Read CPT^®: CMS is adopting the CPT^® language with the codes, including that the prolonged service may take place on a different date than the related E/M
• Avoid counting clinical: CMS intends the codes "to be used to report extended non-face-to-face time that is spent by the billing physician or other practitioner (not clinical staff)"
• Don't double dip: If the time is identified or valued under another code, like chronic care management, don't also report the prolonged services code.

Expert tip: "Ensure there is accurate medical record documentation tosupport medical necessity for prolonged services. This is very important also to ensure reimbursement," says Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, NJ. And be sure to pay extra attention to the rules forbidding double dipping, she adds.

Resource: You can review the Final Rule at www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-26668.pdf.