Wiki 99358

[anggand@aol.com]

On our new work comp patients we bill cpt code 99358 when the Dr. reviews medical records at the time of service. I just recieved a denial from the insurance carrier stating "please provide documentation that the service was beyond the usual service", I'm not sure exactly what they mean. The Dr did state in his note that he reviewed pts Mri, old medical records but I'm not sure what else they need.

 

[mitchellde]

99358 is a code for prolonged non face to face. Reviewing old records and studies is generally considered part of the E&M. 99358 is a stand alone service now, it use to be an add on code. Also it is timed and documentation must support a minimum of 30 minutes spent in the record review or study review. It can be cumulative, that is 15 minutes reviewing an old record and 15 minutes reviewing all of the studies for a total of 30 minutes.
So it sounds like the payer is wanting to be assured that extraordinary review was done and was necessary.

 

[anggand@aol.com]

thanks

In our office we havent been documenting time. We will start doing that now. I appreciate your help.

 

[cyarberry]

Can I use 99358?

Is this the correct code to use when doctor spends 40 minutes with father of patient discussing his case?

 

[TAOSA]

Another important thing to remember when using this code is the following language from CPT:

"Time spent after direct face-to-face contact beyond the usual not necessarily on the same date of service."

If the service you are billing for is a typical on, then an E/M is probably the best choice.

 

[Kris78]

Clarification

99358 is a code for prolonged non face to face. Reviewing old records and studies is generally considered part of the E&M. 99358 is a stand alone service now, it use to be an add on code. Also it is timed and documentation must support a minimum of 30 minutes spent in the record review or study review. It can be cumulative, that is 15 minutes reviewing an old record and 15 minutes reviewing all of the studies for a total of 30 minutes.
So it sounds like the payer is wanting to be assured that extraordinary review was done and was necessary.

Hi, I just received a denial From Superior Medicaid stating that the patients age does not meet the criteria for this CPT, but I cannot find anything regarding age for this CPT. Any thoughts?
Patient is 47