Pediatric Coding Alert

Question: I know that 99358 is a standalone code that requires at least 30 minutes of prolonged service. But does this mean that if a provider charted or reviewed charts on a separate date than the evaluation and management (E/M), we could document the review with this code?

Virginia Subscriber

Answer: As you say, the guidelines for 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) state that “prolonged service of less than 30 minutes total duration on a given date is not separately reported.” This means the first unit of time for the code is attained when the midpoint for the time in the descriptor is reached — in this case, 31 minutes.

The other important things to remember about prolonged services 99358 and +99359 (… each additional 30 minutes …) are:

• You cannot count “face-to-face time in the outpatient, inpatient, or observation setting, nor additional unit/floor time in the hospital or nursing facility setting”;
• You cannot use them with office and outpatient E/M codes 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …);
• You can use them “on a date other than the date of a face-to face encounter” or “on a different date than the primary service to which it is related”;
• You must report them “in relation to other physician or other qualified health care professional services, including evaluation and management services at any level”; and
• You cannot use them when direct patient contact is reported in other services such as care plan oversight services, chronic care management by a physician or other qualified health care professional, home and outpatient INR monitoring, medical team conferences, interprofessional telephone/Internet/electronic health record consultations, or online digital evaluation and management services.

Finally, CPT^® requires 99358 to be “used only once per date.” So, providing you can satisfy all of these requirements, you can document your provider’s charting or chart review with 99358/+99359.

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