NEED HELP with Prolong services!!! HELP!!!!

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Hi All
I have a PCP that billed on 8/18/20 a 99215 and 99496 (TCM). NOW on 9/8 he sent a list of dates and phone calls made to the patient and her family and one phone call to another physician. He is trying to bill 99358 and 99359 because from 9/1/20 thru 9/8/20 he is stating between the phone calls made he has spent 97 minutes total. He has sent a list of these phone calls with times. My question is the last E/M was 8/18 more than 2 weeks from when he wants to bill these prolonged services. I have not found anything to give a range of time to bill them. He also on that date billed a TCM which the 99358 is not allowed to be billed with. Should he have billed the phone consultation code for when he called the pt and her family? What about the 30 minutes he spent on the phone with other physicians? What should he bill? Is it correct to bill the 99358 and 99359 2 weeks later? How can I find the answers... HELPPPPP!!!!!!!!!
 
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Here is some more examples, the Doctor has now billed 3 other dates with the 99358. He is documenting the time and taking good notes. The thing is should he be billing a phone evaluation with these codes?
 
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This is too complex for a straightforward answer. Transitional care management begins on the date of the discharge and continues for the next 29 days, includes one face-to-face E/M service within either 7 or 14 days of discharge, and requires moderate or high level MDM. However, CMS does allow separate reporting of 99358-99359 when the required time is met on a date when there is no direct contact with the patient in 2020 though CPT does not. Prolonged service time is not cumulative over multiple dates of service.
Per CPT,
Code 99358 is used to report the first hour of prolonged service on a given date regardless of the place of service. It should be used only once per date.

Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management or psychotherapy codes.
Code 99359 is used to report each additional 30 minutes beyond the first hour regardless of the place of service. It 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.

Telephone E/M services with the patient are not separately reportable during the TCM period. (See also the CPT list of activities included in TCM that would be included when conducted via telephone.)

I don't find any updated guidance from CMS on reporting prolonged service during the time of TCM other than mention of the change to the rule in 2020. You might see if your local Medicare contractor has provided additional information. For private payers, follow CPT or the individual payer's guidance.

I would urge the physician to use discretion in billing for additional services during the time of TCM. If an activity appears to be included in the description of TCM, I would not bill separately for it.

Good luck,
Cindy
 
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