Wiki 99443 Telephone evaluation and management with Non face-to-face prolonged services (CPT codes 99358‒99359)

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Is it ok to use a non-face-to-face prolonged care code for 30 min+ spent in addition to a phone code 99443 (30 minutes)? I thought this code set was for services on a date prior or subsequent to the visit. Non face-to-face prolonged services (CPT codes 99358‒99359) The codes may be used to represent time spent (30 or more minutes) reviewing extensive medical records on a date prior or subsequent to a new patient encounter; an entry in the medical record should describe this activity and the time spent. Documentation for 99358‒99359 should always include reference to the face-to-face service that supports the medical necessity for the non-face-to-face service.

99443 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
 
The requirement for CPT 99358 is that time in non-face-to-face activities must be performed either before and/or after direct patient care. Because phone visits (99441-99443) are not considered direct patient care, CPT 99358 is not applicable to phone visits.
 
  • CMS has also included CPT codes 99354-99355/99356-99357 Prolonged Services for Office/Inpatient and CPT codes 99497-99498 Advance Care Planning as being eligible for “audio-only” technology.
    • Prolonged Services for Office/Inpatient, CPT codes 99354-99355/99356-99357 may be billed with CPT Telephone Visit CPT codes 99441-99443
    • 99354/99356 represent the first hour
    • 99355/99357 represent additional 30-min increments
These updates will be retroactively applied to services provided on March 1, 2020, or later.

 
  • CMS has also included CPT codes 99354-99355/99356-99357 Prolonged Services for Office/Inpatient and CPT codes 99497-99498 Advance Care Planning as being eligible for “audio-only” technology.
    • Prolonged Services for Office/Inpatient, CPT codes 99354-99355/99356-99357 may be billed with CPT Telephone Visit CPT codes 99441-99443
    • 99354/99356 represent the first hour
    • 99355/99357 represent additional 30-min increments
These updates will be retroactively applied to services provided on March 1, 2020, or later.
Can you direct me to where you found this guideline please?
 
Is it ok to use a non-face-to-face prolonged care code for 30 min+ spent in addition to a phone code 99443 (30 minutes)? I thought this code set was for services on a date prior or subsequent to the visit. Non face-to-face prolonged services (CPT codes 99358‒99359) The codes may be used to represent time spent (30 or more minutes) reviewing extensive medical records on a date prior or subsequent to a new patient encounter; an entry in the medical record should describe this activity and the time spent. Documentation for 99358‒99359 should always include reference to the face-to-face service that supports the medical necessity for the non-face-to-face service.

99443 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
Hi there, the non-face-to-face code can be on the same day as the face-to-face encounter. I think the issue here is a telephone visit isn't a face-to-face service. During the PHE Medicare allows 99345-99355 to be reported as add-ons to the telephone codes. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Add-On-Code-Edits
 
Hi Missy, Did you ever find any resolution to your question? The same question has come up at my office, can we bill for prolonged time with a 99443 phone call. Thank you!
Hi there!
I did find the answer. No we cannot. The maximum amount of time that can be spent on the phone call is 30 minutes. I do have a training class I am taking soon regarding telehealth, so if anything changes, I will make sure to let you know.
 
Hi there!
I did find the answer. No we cannot. The maximum amount of time that can be spent on the phone call is 30 minutes. I do have a training class I am taking soon regarding telehealth, so if anything changes, I will make sure to let you know.
Hi Missy, did you by any chance find an answer on how to code additional time when billing 99443?
 
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