Question Billing Non Face to Face Prolonged care (99358) related to No show visit

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Bonney Lake, WA
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While performing my organization's annual Cardiology coding group education, the following question arose in regards to 99358 Non face to Face Prolonged care services:

"What if we spend (greater than 30 minutes) in extensive review of patient's records and imaging in preparation for a consult, bill the 99358 and then the patient no shows or cancels for the related visit?"

My thoughts were that either A.) the patient will reschedule and there will still be a related visit or B.) if the payor questioned this we could support the fact that the patient was in fact scheduled for a visit which the provider prepared for but patient did not keep intended visit.

I would greatly appreciate any feedback on this. I cannot seem to find a clear cut answer on this in anything I have read.

~Casie Connors, CPC, CCC
 
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From the CPT manual

This service is to be reported in relation to other physician or other qualified health care professional services, including evaluation and management services at any level. This prolonged service may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past records. However, it must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. A typical time for the primary service need not be established within the CPT code set.

From CPT Assistant Jan. 19

Prolonged service without direct patient contact is to be reported in addition to other services, including E/M services at any level. CPT code 99359 is an add-on code; therefore, code 99358 should be used to report the first hour, while code 99359 should be used to report the additional time after the first hour. Therefore, codes 99358 and 99359 are used to report the total duration of the non-face-to-face time. Each additional 30 minutes beyond the first hour of prolonged service without direct patient contact, regardless of the place of service, may be reported with code 99359. This code may also be used to report the final 15 to 30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately. In addition, the following points should be considered when selecting these codes:

Provided the doctors keep close track of their time and document it, it is paired with another service/visit and it doesn't conflict with payer policy, it should be OK.
 

zcometa

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Local Chapter Officer
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Santa Rosa
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Is the patient being seen in the office or the hospital? Because it looks like you can't use 99358/99359 on 99202-99205 and 99211-99215. Also, CCI checker says that 99358/99359 are column 2 with a "0" modifier indicator to the office visit codes so cannot be reported together.

From the AMA CPT E/M document:

Codes 99358 and 99359 are used when a prolonged service is provided that is neither face-to-face time in the outpatient, inpatient, or observation setting, nor additional unit/floor time in the hospital or nursing
facility settin
g. Codes 99358, 99359 may be used during the same session of an evaluation and management service, except office or other outpatient services (99202, 99203, 99204, 99205, 99211,
99212, 99213, 99214, 99215).
 

shanamarie

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Eagan
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While performing my organization's annual Cardiology coding group education, the following question arose in regards to 99358 Non face to Face Prolonged care services:

"What if we spend (greater than 30 minutes) in extensive review of patient's records and imaging in preparation for a consult, bill the 99358 and then the patient no shows or cancels for the related visit?"

My thoughts were that either A.) the patient will reschedule and there will still be a related visit or B.) if the payor questioned this we could support the fact that the patient was in fact scheduled for a visit which the provider prepared for but patient did not keep intended visit.

I would greatly appreciate any feedback on this. I cannot seem to find a clear cut answer on this in anything I have read.

~Casie Connors, CPC, CCC
We have had this come up as well. My thought is it can be billed as long as the patient reschedules, or you have seen the patient. If a face to face visit does not occur then this can’t be billed since it doesn’t relate to a face to face service.
**Proof of a scheduled appt, but never seen will not be accepted by insurance.

Page 42 in the CPT book: The description states it must relate to face to face care that has occurred or will occur in order to bill.
 
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