We are billing 99358 to BCBS and Aetna medicare advantage plans and medicaid. They are denying this code. Is anyone else having this issue? Is there something we can be doing to get this paid? We are billing for nursing facilities. The providers review patient records before being seen in facility.
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Wiki 99358
- Thread starter eanncox
- Start date
SharonCollachi
Guest
The work of 99358 (defined as one hour of prolonged E&M before or after direct patient care), is generally included in the code for the visit itself for those plans. I have worked with providers who go to nursing facilities and they don't spend an hour reviewing a patient's records before seeing them. If they are reviewing the records in the facility itself, it is not appropriate as the section in the CPT book says it is for prolonged service that is [not] additional unit/floor time in the hospital or nursing facility setting.
Also, if you look at the CPT book, you will see that the nursing facility care section states that "all levels of subsequent nursing facility care include reviewing the medical record..."
In my experience, workers comp is the only type of plan that consistently paid for what we call "review of records time" in any location.
Also, if you look at the CPT book, you will see that the nursing facility care section states that "all levels of subsequent nursing facility care include reviewing the medical record..."
In my experience, workers comp is the only type of plan that consistently paid for what we call "review of records time" in any location.