Pulmonology Coding Alert

Question: Does CPT code 99359 for prolonged service need to be listed separately for each unit of the physicians service, and should a -51 modifier be appended after the primary procedure code for Medicare?

Florida Subscriber

Answer: The prolonged service codes 99358-99359 should be used when a physician provides care not involving direct (face-to-face) contact that is beyond the usual service in either the inpatient or outpatient setting. This service is reported in addition to other physician services, including evaluation and management (E/M) services at any level.

Use 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 [list separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient evaluation and management service]) to report the first hour of prolonged service on a given date, regardless of the place of service. In addition, use it to report a total duration of prolonged service of 30 to 60 minutes on a given date. Use it only once per date, even if the time spent by the physician is not continuous on that date.

Code 99359 ( each additional 30 minutes [list separately in addition to code for prolonged physician service]) is used to report each additional 30 minutes beyond the first hour, regardless of the place of service. Also, use it to report the final 15 to 30 minutes of prolonged service on a given date.

Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.

For example:

30-74 minutes = 99358
75-104 minutes = 99358 and 99359
105-134 minutes = 99358 and 99359 x 2
135-164 minutes = 99358 and 99359 x 3

There is no need to use modifier -51 (multiple procedures). Although modifier -51 indicates that multiple procedures are performed other than E/M services by the same provider at the same session, it isnt necessary or appropriate for use with these prolonged service codes.

Answered by Linda Jackson, CCS-CPC, Medicare consultant at Iowa Veterans Home in Marshall Town, Iowa.