Oncology & Hematology Coding Alert

Question: I have a provider who is billing codes 99358 and +99359 for her supportive oncology phone calls when she speaks to an established patient on the phone after hours. However, she is also using these codes when spending time talking to family members on the phone in an acute setting during visitor restrictions. Are there other codes the provider should be billing instead of the 99358?

AAPC Forum Participant

Answer: Billing 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) or +99359 (… each additional 30 minutes (List separately in addition to code for prolonged service) would not be appropriate in either situation you describe, as neither code is listed on the CPT^® telehealth list and so cannot be used for audio or audiovisual communication.

There are, however, several ways to bill the calls, depending on the context.

If the calls are related to a same-day 99205/99215 (Office or other outpatient visit for the evaluation and management of a new/ established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74/40-54 minutes of total time is spent on the date of the encounter) service, then you could use units of +99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time … with or without direct patient contact … on the date of the primary service, each 15 minutes of total time…) to report the call.

For commercial payers: You must make sure you have billed the 99205/99215 based on the time allotted as well. If the total time of the visit and time spent on the call that day did not exceed 40 minutes +15 (55 minutes of total time), when billing a 99215, or 60 minutes +15 (75 minutes of total time) for 99205 billed on the same day, then not enough time was spent to support billing the add-on code +99417.

For CMS Medicare/Medicaid and commercial payers that follow CMS guidelines: You must make sure you have billed the 99205/99215 based on the time allotted as well. If the total time of the visit and time spent on the call that day did not exceed 54 minutes +15 (69 minutes of total time), when billing a 99215, or 74 minutes +15 (89 minutes of total time) for 99205 billed on the same day, then not enough time was spent to support billing the Medicare prolonged services code G2212 (Prolonged office or other outpatient evaluation and management service(s) ...}.

If the phone calls are not related to a same-day office/outpatient E/M service, then you will have to use 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian … 5-10 minutes of medical discussion), 99442 (… 11-20 minutes of medical discussion), or 99443 (… 21-30 minutes of medical discussion), based on the length of the call.

If the phone calls are a direct result of an office/outpatient E/M service “provided within the previous 7 days,” or if they result in a similar service “within the next 24 hours or soonest available appointment” per the descriptors for 99441-99443, then you would fold the content or time of the call in to the appropriate office/ outpatient service level and would not report the call separately.

Also, per the descriptors for 99441-99443, the codes may be used to report phone calls with the patient’s parent or guardian. However, under HIPAA regulations, the patient must grant permission for your provider to do so.