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Please help! Second time posting this question...

  1. #21
    Clearnace Sale
    Well 99358 is not a add on code and it states that "(face-to-face)patient care has occurred or will occurand relate to ongoing patient management
    Herbie W Lorona Jr., CPC, CPC-H

  2. #22
    Quote Originally Posted by Herbie LoroƱa View Post
    Well 99358 is not a add on code
    Yes it is, dude. Look again.

  3. #23
    Quote Originally Posted by Walker22 View Post
    Yes it is, dude. Look again.
    Well it is for 2009 but 2010 it was revised and is no longer an add on code.
    Herbie W Lorona Jr., CPC, CPC-H

  4. #24
    Quote Originally Posted by Herbie LoroƱa View Post
    Yeah you should be billing prolonged services not E&M

    So I guess next time I will just go to the Pediatrician without my daughter and just tell him to bill for an office visit!
    Wow, I think you are WAY out of line, here. One of the best things about being a coder is the fact that our coding is ultimately based on guidelines and then our own interpretations and there will ALWAYS be times when coders have to respectfully agree to disagree and I think that that is all that Walker22 is trying to do. Accusing someone of fraud or any kind of fraudulent type of activity is absurb and you should be ashamed of yourself. These forums are for coders to bounce things off one another, give advice and help each other, and there are going to be many instances where we will not agree or come to the same conclusions. I love these forums and wouldn't be able to go one day without at least checking in. I wouldn't be as eager to do so if I was constantly met with reactions such as yours. I little clue, though, when someone says that they do not want to argue about something any longer, I suggest you let it go and go about your own business. If you both disagree, then so be it. This bantering back and forth makes you look ridiculous and no one will take you seriously when you act that way in life.
    As far as what the actual initial post is about, I agree with Walker22 but that is only MY opinion....

    Be nice, all we have is each other in this world...

  5. #25
    FYI, it is not 2010 yet so the 2009 codes still apply.

  6. #26
    Default Wow, is it getting hot in here?
    Well, I could be wrong but it looks like 99358 is no longer an add on code in 2010. They have revised it and my CPT book no longer shows the plus sign indicating it is an add on. Of course it is not 2010 yet, so right now it is an add on.

    While it is not allowable to bill for an E/M service when the patient is not present under CMS guidelines, it is allowed under CPT. The original question is in regards to a non-medicare patient. Whether or not that insurance follows CPT or CMS I don't know but ultimately I would default to CPT until otherwise directed by the carrier.

    Do I personally agree with billing high level E/Ms to talk to the family when the patient is not there, it depends on the situation but in general no I am not a fan of it. Is it allowable, yes. You just better be sure the documentation supports it.

    Just my 2cents but I wanted to add in order to bring the focus back to the original question. I know I am guilty of passionate responses myself but it is important to stay on target.

    Happy Holidays

    Laura, CPC, CEMC

  7. #27
    Either way it still does not make sense to bill for an office visit under a patients name if the patient is not in the office
    Herbie W Lorona Jr., CPC, CPC-H

  8. #28
    Thanks Leslie and Laura for offering your opinions. I would be interested in hearing from more coders on this issue. This is a very interesting discussion!

  9. #29
    If it was my case, personally, I agree with Laura in that I would bill it under the default CPT guidelines unless I heard otherwise from the billing department. You can always call BC and ask them directly what they would pay and if they adhere to CMS guidelines or CPT guidelines in this particular instance. Again, I agree with Laura as far as billing a higher E/M and being very careful to back yourself up with proper documentation before going that route. After 2010, however, my opinion on this matter would definitely vary but either way, I would contact the payer directly and ask them.

  10. #30
    Quote Originally Posted by Herbie LoroƱa View Post
    Well it is for 2009 but 2010 it was revised and is no longer an add on code.
    I don't use the 2010 CPT book until it's actually 2010.

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