Wiki billing 99358


Coralville, IA
Best answers
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?

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!
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?

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.