Wiki Help!! Prolonged Service 99358


Knoxville, TN
Best answers
Hey guys,
I was hoping someone out there could help me. I have a physician who states he extensively reviewed records on a patient prior to surgery and wants me to bill 99358 on 9/11/08 and 99359 on 9/12/08 (in the office) and then the actual surgery on 9/15/08 (inpatient hospital). I'm not sure how to bill this.

According to CPT these are add on codes and they can be billed in addition to "other physician services" including Evaluation and Managment no matter the place of service.

I'm just not sure in what order to bill these. Since the prolonged service codes and surgery were billed in 2 different place of services so that would require 2 separate claims and you can't bill an add on code on a claim by itself right? The last question I have about this is where should these prolonged services be documented? Should I have him dictate what he did on certain days in our office chart or should he add that to the surgery dictation? Errrggg ... I would appreciate any help with this. Thanks alot.

Christy Brown, CPC
Appalachian Orthopedic Associates PC
Johnson City, TN
99238 / 99239

The description for these codes in CPT state: "Prlonged evaluation and Management service before and/or after direct (face-to-face) patient care ..." (emphasis added by FTB).

So, by definition, you cannot use these codes in your scenario ... when ONLY record review was performed.

If the physician had reviewed these records on the same day as an office visit, he would document as part of his office visit note something about "extensive review of records, (describe what was looked at and findings), requiring X minutes" (has to be at least 30 minutes).

NOTE: non-face-to-face codes are typically never paid.

F Tessa Bartels, CPC, CPC-E/M
I completely understand that since these are "add on" codes and my physician didn't see the patient the same day he reviewed records then I cannot use these. I do however have a few questions if you would be kind enough to help me...

When I read the wording "This service is to be reported in addition to Other physician service, including evaluation and managment services at any level...what would be an example of "other physician service"?

Would there be anyway I could bill for my physician's time for reviewing medical records extensively if not done on the same day as an office visit?

Thanks for your reply and your time. I enjoy learning from others.
I've been looking fo ryou and this is very frustrating, AMA makes up a code like 99358-99359 and they are add on's and also without direct face-to-face, then how can we bill them???
I'm pasting some replies I've seen in the past..

Currently, Medicare does not pay separately for prolonged physician services without
direct patient contact, despite the existence of CPT codes 99358 and 99359, Prolonged Physician
Service Without Direct (Face-to-Face) Patient Contact for chemotherapy patients. Medicare
considers these services to be bundled into other E&M codes (70 FR 70459)

Prolonged services without direct face-to-face patient contact, CPT codes 99358 and 99359, are not separately payable and are included in the payment for other billable services.
Remember that Medicare contractors will not pay (nor can you bill the patient ) for prolonged services codes 99358 and 99359, which do not require any direct patient face-to-face contact (e.g., telephone calls). These are Medicare covered services and payment is included in the payment for other billable services.
here's a couple sites with info and other links for more info~
{that's my opinion on the posted matter}
Donna, CPC
Other Physician Service

"Other Physician Services" is just what is says ... any other service provided by the physician. But in practice, I've never seen prolonged service codes added to anything but E/M services.

I do remember one instance where a patient (child) was extremely anxious about a procedure. The doctor who was going to provide the moderate sedation spent over 45 minutes with the patient and his mother carefully explaining what was going to happen over and above the pre-anesthesia assessment exam. I found out about this only because I had a friendly relationship with this doctor and she mentioned it in passing. It wasn't documented, so it was never coded. But I think we could have used the face-to-face prolonged service code as an add-on to the sedation if she had documented the circumstances.

There is no code for extensive review of medical records that occurs completely independently from direct patient care.

Our craniofacial surgeons spend a lot of time looking at records, CDs, models of the skull, plotting out the surgery to come - this can take hours over several week's time. We don't bill separately for any of this. We figure it's a part of the total package of doing these complicated procedures.

F Tessa Bartels, CPC, CPC-E/M - Prolonged Services Without Direct Face-to-Face Patient Contact Service (Codes 99358 - 99359)
(Rev.1490, Issued: 04-11-08, Effective: 07-01-08, Implementation: 07-07-08)
Contractors may not pay prolonged services codes 99358 and 99359, which do not require any direct patient face-to-face contact (e.g., telephone calls). Payment for these services is included in the payment for direct face-to-face services that physicians bill. The physician cannot bill the patient for these services since they are Medicare covered services and payment is included in the payment for other billable services
Thanks everyone

I want to thank you guys for taking the time to help me out with this one. I think I read too much into something and then get myself all I understand more about these codes. I hate it when a code is made up but never billable. It's hard communicating that to physicians.
I hope everyone has a wonderful day and thanks again. :p