How to Report Claim for Prolonged Services when without Face to Face or No Direct Patient Contact

How to Report Claim for Prolonged Services when without Face to Face or No Direct Patient Contact

Here’s a good blog post for you to have a better understanding on how to Report Claim for Prolonged Services when rendered without Face to Face or when there is No Direct Patient Contact.

Because the truth of the matter and in so many different circumstancres, it may be appropriate to submit and report claims for Prolonged Services without Face to Face or without Direct Patient Contact, these can be upplemental to an evaluation and management (E/M) encounter service

Introducing your best friends, CPT Codes

CPT Code 99358 Prolonged evaluation and management service before and/or after direct patient care; first hour, and
CPT Code 99359 Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes
***List separately in addition to code for prolonged service, are used when a prolonged evaluation and management encounter E/M service provided is neither face-to-face time in the office and or outpatient setting nor additional unit and or floor time in the hospital and or nursing facility setting during the same session of an evaluation and management encounter E/M service, as well as beyond the usual physician or other qualified health care professional provider services.

Coding Billing Tips:
How to Report Claim for Prolonged Services when without Face to Face or No Direct Patient Contact

Services may consist of, but not limited to, prolonged communication and consulting with qualified health practitioner related to ongoing management of the patient, ongoing part of the practitioner’s service to his/her patient, include extensive record review related to an evaluation and management E/M encounter service performed earlier on the patient, or prolonged review of an extensive health record and diagnostic test results pertaiting to the patient.

CPT Codes 99358 and 99359 state that the prolonged service “must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management.

The typical time for the primary encounter service need not be established within the CPT code set.” For instance, a recorded review and care coordination services may occur over several few days and without any face-to-face encounter service on a date and time, therefore, the calculation of total time rendered may cause a confusion when prolonged services are without direct patient contact:

For the above reason, the reported time needs to be precise and documentation should detail important clinical matters and support coding.

  • CPT Code 99358 Prolonged evaluation and management service before and/or after direct patient care; first hour, and
  • CPT Code 99359 Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes

CPT code 99359 is an add-on code; code first the 99358 to report for the first hour, while code 99359 should be used to report the additional time after the first hour (each additional 30 minutes)

Therefore, codes 99358 and 99359 are used to report the total duration of the non-face-to-face time. Each additional 30 minutes beyond the first hour of prolonged service without direct patient contact, regardless of the place of service, may be reported with code 99359.

Practice Management Therapists

This code 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.

CPT Codes 99358 and 99359 can be used for physician or other qualified health practitioners for communication with the family that extends beyond the usual evaluation and management E/M encounter service rendered on a given date.

If another, separate and additional service is rendered on the same date that the prolonged services code(s) is reported, it may be reported in addition to the prolonged services codes.

Documentation Guideline:
How to Report Claim for Prolonged Services when without Face to Face or No Direct Patient Contact

It’s imperative that you complete your documentation real time,. It is very important to take note of the documentation about the duration and content of the medically necessary evaluation and management service and prolonged services billed is required in the medical record. The medical record must be appropriately and sufficiently documented by the physician or qualified NPP to show that the physician or qualified NPP personally furnished the direct face-to-face time with the patient specified in the CPT code definitions.

The start and end times of the visit should be documented in the medical record along with the date of service.

Be careful with the telephone calls CPT Codes (99441-99443), they are completely different and are not be separately reported when you report 99358 and 99359

99441 Telephone evaluation and management (E&M) service provided by a physician to an established patient, parent, or guardian not originating from a related E&M service provided within the previous seven days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment; five to 10 minutes of medical discussion
99442 11 to 20 minutes of medical discussion
99443 21 to 30 minutes of medical discussion

Telephone Services Keypoints:
You cannot use them to report non-face-to-face communication between a physician and other health care professionals.
If the telephone service ends with a decision to see the patient within 24 hours or next available urgent visit appointment, do not report the code; the encounter is considered part of the preservice work of the subsequent E&M, procedure, and visit.
If the telephone call refers to an E&M service performed and reported by the physician within the previous seven days or within the postoperative period of the previously completed procedure, then the service(s) are considered part of that previous E&M service or procedure.
For telephone services provided by a qualified nonphysician health care professional, use CPT codes 98966-98968.

References / Sources: 2017-2019 CPT Code Books, ICD-10 Code Book, HCPCS Code Book, CMS Website and available tools and training (eg LMN)
January 2019 AMA CPT Assistant
Medicare Prolonged Services Guideline

https://youtu.be/1a616L9l2Kg

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