When you are thinking about prolonged service codes 99358-99359 for your evaluation and management (E/M) services, you'll come face to face with yet another common pediatric coding challenge. Since last year, you have been able to count indirect prolonged service time that takes place around the date of the E/M service.
As per the previous definition (year 2009 and before), the non-face-to-face service had to be the day of the evaluation and management visit. But then since the first day of last year, you simply have to prove that the time was 'related' to the evaluation & management service.
Word of caution: Prolonged service codes 99358 and +99359 still have to relate to an E/M service that involves patient contact.
As per the revised notes, the prolonged service must related to a service or patient where direct patient care has taken place or will occur and relate to ongoing patient management. According to CPT, there are no timeframe on the time that can elapse between the primary service and the prolonged prior to and after direct patient care service.
If you are tending to a complex child, the loosening of the prolonged non-face-to-face service codes has been a great help. You can assess the patient's chart and make phone calls prior to and after seeing the patient and count that time. You need a minimum of 30 minutes to bill the first hour of prolonged non-face-to-face care.
What if you are using electronic billing? If so, you may miss the opportunity to add 'related' prolonged service tomes to your claims. With electronic billing, the encounter is sent directly to the front office and the bill is sent out then and there.
What you need to do: You have to work with the practice management staff to ensure that you are holding the claim until all of the extra work related to the E/M visit is done and you are holding the claim until all of the additional work related to that E/M visit is finished and documented.
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