Prolonged services without direct face-to-face contact


Stuart, Florida
Best answers
Hi all,

I wanted to know if anyone could provide more information on CPT codes 99358-99359 and what constitutes billing? I understand they are prolonged service codes that do not require face to face contact and CMS does not cover these codes but other than that, I know nothing. Trying to understand these and how they apply to the coding world. I'm having a hard time understanding when these codes would be billable.

Best answers
I don't have a lot of information about 99358, +99359, but here's how it was explained to me. Services usually involved with these codes are things like making telephone calls, needing to review a substantial amount of medical records or history or other documentation, the need to further research particular pieces of a patient's history, past treatments etc. These services must accompany a visit that has happened shortly prior to or will happen in the immediate future, regarding that one specific patient. The services cannot be part of other types of services such as case management, team conferences, etc.

If the total time is less than 30 minutes, you can't bill anything.
99358 - at least 30 minutes, up to 1 hour.
If the total time is 1 hr and 15 minutes, you can only bill 99358 as the additional 15 minutes doesn't meet the criteria for +99359.
+99359 - each add'l 30 mins
If the total time is 1 hr and 45 mins, you'd bill 99358, +99359, and the extra 15 minutes are not counted.

Here's where I think most of the confusion lies. These codes are never paid because they are included in another service; you can't count the time spent here when leveling an E/M visit. It seems like the physician doesn't get credit since there's never payment, but that isn't actually the case. The physician gets credit by counting the work done. So for example, in the facility I work, physicians are required to perform a certain amount of work, which translates into the amount of RVUs they acquire over a month. These codes are entered, not paid by reimbursement, but get counted into that physician's work/RVUs performed. So the facility doesn't get reimbursed, but the physician still gets credit for what he/she has done, despite non-payment. Make sense? Basically (for us), these codes are used to reflect work done by a physician, not for reimbursement purposes. If you DIDN'T enter them, then no payment would be received AND the physician would not get the "credit."