99358 Prolonged evaluation and management service before and/or after direct patient care; first hour.

Can 99358 be billed alone?

Codes may be reported alone (99358) or in conjunction with another service. Code 99359 must be reported with 99358.

Who can bill CPT code 99358?

The codes follow CPT time rules. The physician, NP, or PA must spend more than half of the required one hour to report the codes. So, for example, you would bill 99358 for visits of 30-74 minutes.

Can 99358 be billed with 99214?

Do not report 99358, 99359 on the same date of service as 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99417.

How Much Does Medicare pay for 99358?

The CMS national payment rate for 99358 is $113.52 (the rate for 99359 is $54.78) with a Relative Value Unit (wRVU) of 2.10. This provides payment for the extensive medical management that occurs outside of the F2F visit.

What place of service is used for 99358?

As noted above, the code description identifies 99358 as a prolonged service code that correlates to an E/M service (before, on the same day [except 99202-99215], or after) direct patient care.

Can 99358 be used for telephone calls?

Prolonged Services with Telephone calls (page 123)

Non-Face-to-face prolonged service codes, 99358‒99359 can be billed with telephone services (99443 and 98968 would be reported for the first 30 minutes). 99358‒99359 are also allowed for telehealth visits.

Is 99358 covered by Medicare?

SUMMARY OF CHANGES: Beginning in CY 2017, CPT codes 99358 and 99359 are separately payable under the Medicare Physician Fee Schedule.

What is the CPT code for skilled nursing?

The annual nursing facility assessment is billed using CPT code 99318, and SNF discharge services are billed using CPT codes 99315-99316. Using an inpatient hospital E/M CPT code represents inappropriate billing when you render E/M services in an SNF.

Is there a CPT code for review of medical records?

o CPT 99358- Review of medical records in excess of the 30 minutes included in 99455/56. For the first hour of record review thereafter, CPT code 99358 shall be used. The medical provider must itemize the total time spent reviewing the medical records.

How do you bill for a prolonged visit?

The new code, CPT Code 99417, replaces CPT Codes 99354 and 99355. It can be used to report the total prolonged time with and without direct patient contact on the same day as an office visit. However, certain conditions apply: It can only be reported in conjunction with the level 5 visit codes (CPT 99205, 99215).

What are the CPT code changes for 2021?

For 2021, two new CPT codes (33995 and 33997) and four revised CPT codes (33990-33993) reflect insertion, removal, and repositioning of right and left percutaneous ventricular assist devices (VADs).

How do you document prolonged services?

Document the start and stop times. If the face-to-face time wasn’t continuous, document the total time, too (e.g., “Spent 95 minutes face-to-face with patient, discussed ….”). Subtract the E/M time for 99213: 95 minutes total time minus 15 minutes typical time for 99213 equals 80 minutes left over.

What are the new 2020 CPT codes?

Additional CPT changes for 2020 include the new codes for health and behavior assessment and intervention services (96156, 96158, 96164, 96167, 96170 and add-on codes 96159, 96165, 96168, 96171).

Does Medicare cover prolonged services?

Finally, you should 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 F2F contact (e.g., telephone calls).

Can you bill prolonged services with a discharge?

A: You need to document time spent in discharge services only if you bill a 99239, which is the discharge code to use when you spend more than 30 minutes on discharge services.

Can you bill prolonged services with telehealth?

During this PHE, Medicare went ahead and implemented these time guidelines for telehealth visits only. If the time of visit exceeds the time of the highest level of service (99205 and 99215), prolonged service codes can be used to report these exceptional circumstances.