The non–face-to-face prolonged service codes without direct patient contact are 99358 and 99359. CPT defines codes 99358 and 99359 as used when “a physician provides prolonged service not involving direct (face-to-face) care that is beyond the usual non–face-to-face component of physician service time.” These codes are to be reported in relation to other E/M services at any level, but may be reported for a different date of service than that of the primary E/M service that they are related to. For instance, if a physician spends an hour extensively reviewing a new patient’s medical records prior to their office visit, the time spent would be documented and included in the patient’s medical record during their scheduled visit. CPT codes 992XX and 99358 would be billed. For each additional 30 minutes over the first initial hour of the prolonged service, CPT code +99359 should be used. Note that 99359 is an add-on code and cannot be billed separately without 99358.
Keep in mind that Medicare will typically not reimburse for prolonged services—both face to face and non–face to face—but some private carriers do; therefore, verify insurance policies regarding these services.
For more information on documenting for the use of time, download a copy of the ACR’s Rheumatology Coding Manual at www.rheumatolgy.org/publications, review the E/M services guidelines in the current CPT manual, or read Medicare’s “Documentation Guidelines for E/M Services” at www.cms.gov.
Time plays an important role in the selection of the most appropriate code for services beyond the normal scope of work, and proper documentation can be financially rewarding. If you have any questions, contact Melesia Tillman CPC-I, CRCH, CHA, at [email protected] or (404) 633-3777, ext. 820.
