billing 99358

relong

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Bettendorf, Iowa
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Has anyone had luck getting 99358 (prolonged E&M) paid. Our physician would like to use this in addition to 99214 but we haven't had any luck getting it paid previously. Do we need a modifier?
 
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San Diego
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Hi,

Is there a reason that you are billing a 99358 with the 99214 that you don't mention in your post? I think you may be having trouble getting it paid because 99358 is for no direct/face-to-face contact with the patient. I think you probably need to be using prolonged codes 99354 or 99355 for "direct" face-to-face contact in the "office or other outpatient setting...".

Hope this helps!
 

relong

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Bettendorf, Iowa
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Our physician would like to use it for spending over an hour prepping for the patients office visit by reviewing records & calling her other physicians to discuss the patient's diagnosis and care, which is exactly the definition of 99358. So I'm confused about what it takes to get it paid. Maybe I just need to send in documentation with the claim?
 
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165
Location
San Diego
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Hi,

I did some research and found that in order for 99358 to be considered, you had the select the highest level of e/m code within each category. So, perhaps if you bump up to a 99215 with the 99358 you will fare better results. Hope this helps!

Also, here is a link to in-depth info on this subject for you to look through.

http://www.aafp.org/fpm/20030600/27time.html
 
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