Wiki 99358 visit with its spouse and NOT pt

[TaraAllen]

Provider is coding 99358 which is prolonged services without direct contact with pt.. but is seeing patients spouse for the appointment not the patient. (They have all the paperwork) this is psych and geriatric. Is this an acceptable code and where can I find the source to share this. How should they code this?

 

[jmari002]

"Prolonged services without direct face-to-face patient contact

Codes 99358-99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an E/M and is beyond the usual physician or other qualified health care professional service time."

the above is from https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00081586​

"In checklist form, the adopted CPT guidelines for reporting codes 99358 and 99359 consists of 5 points:

1. CPT Codes 99358 and 99359 may only be used when a prolonged non-face-to-face service
   1. Is neither:
      • Face-to-face time with a patient during an evaluation and management service in the office or outpatient (non-facility) setting, nor
      • Additional time in a facility setting during the same evaluation and management service[1]
   2. AND
   3. Is “beyond the usual” time a provider would spend on a service.
2. Prolonged service is to be reported in relation to other physicians or other qualified health care professionals services, including but not limited to evaluation and management services at any level.
3. A provider is allowed to bill for non-face-to-face prolonged service on a different date than the primary service.
4. However, prolonged service must relate to
   1. The past or future direct, face-to-face care of the patient
   2. Ongoing patient management
5. The face-to-face primary service CPT code need not have a time requirement."

the above is from https://blog.daisybill.com/the-5-point-checklist-for-cpt-codes-99358-and-99359​