Prolong Phyiscian Services-code 99358 & 99359

agongora1

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I am having a hard time trying to get Medicare contractors to pay for prolonged service procedure code(s) 99358 & 99359 - which do not require any direct patient face-to-face contact.

Does anyone know of any other timed procedure code or modifier to use for non-face-to-face or when the physician performs work related to the patient before & after the face-to-face time.(Which would include tasks such as retrieving records and test results, arranging for further services, communicating with other healthcare providers.)

I am coding it to the highest E&M level there is... But, the insurance will not pay.... Can someone please advise me??? HELP!!!!!
 

dmaec

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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~
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5972.pdf
http://www.cms.hhs.gov/transmittals/downloads/R1490CP.pdf
http://www.cms.hhs.gov/eRulemaking/downloads/CMS-1512-PN email Comments 2215-2232.pdf
{that's my opinion on the posted matter}
 
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Lisa Bledsoe

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I am having a hard time trying to get Medicare contractors to pay for prolonged service procedure code(s) 99358 & 99359 - which do not require any direct patient face-to-face contact.

Does anyone know of any other timed procedure code or modifier to use for non-face-to-face or when the physician performs work related to the patient before & after the face-to-face time.(Which would include tasks such as retrieving records and test results, arranging for further services, communicating with other healthcare providers.)

I am coding it to the highest E&M level there is... But, the insurance will not pay.... Can someone please advise me??? HELP!!!!!
If you are coding to the highest level appropriate E/M, have you tried modifier -21? It can ONLY be appended to the highest level for that specific type of service (i.e. 99233 -21).
 
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