What is the replacement for CPT code 99361?
from the list of CPT codes. This Bulletin announces the removal of 99361 and 99362 and the expansion in the use of H0032. Removal of 99361/99362 . The CPT 2011 guide no longer includes 99361 and 99362. These two codes were replaced with several other procedure codes that are more specific in the disciplines that must be
When to Bill 99358?
Since 99358 is a stand-alone code, it can be reported on Friday before the initial encounter on Monday. A developmental and behavioral pediatrician is scheduled to see a patient for the first time today. Records from his school and primary care pediatrician are sent to assist in the initial exam.
How to Bill CPT 99354?
• To get to the threshold time for billing code 99354 and two units of code 99355, providers should add 30 minutes to the threshold time for billing codes 99354 and 99355. For example, when billing code 99205, in order to bill code 99354 and two units of code 99355, the threshold time is 150 minutes.
What is Procedure Code 99305?
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service [s]). ...
- The submitted medical record must support the use of the selected ICD-10-CM code (s). ...
What is code 99358 used for?
Codes 99358 and 99359 are used for non-face-to-face prolonged services by the billing physician/NP/PA when provided in relation to an E/M service on the same or different day as an E/M service.
Can CPT code 99358 be billed alone?
Codes may be reported alone (99358) or in conjunction with another service. Code 99359 must be reported with 99358.
How do I use 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. But you would bill 99358 and +99359 for a visit of 75 minutes or more, with +99359 for each additional 30-minute increment.
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.
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.
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.
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 many RVU is 99358?
2.10Table 2.CPT CodeType of ServiceRVU99358Prolonged evaluation and management service before and/or after direct patient care, first hour2.101 more row
How do I bill for a prolonged office visit?
The AMA developed CPT® code 99417 for 15 minutes of prolonged care, done on the same day as office/outpatient codes 99205 and 99215.
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 review of medical records?
CPT 99358o 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.
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.
What is the code for 99358?
Codes 99358 and 99359 are used to report the total duration of non-face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service , even if the time spent by the physician or other qualified health care professional on that date is not continuous .
When to use 99358?
Codes 99358 and 99359 are used when a prolonged service provided is neither face-to-face time in the outpatient, inpatient, or observation setting, nor additional unit/floor time in a facility or observation setting. Codes 99358 and 99359 may be reported on the same date as an E/M service, except office or other outpatient services ( 99202 - 99205, ...
What is a CPT assistant?
The CPT Assistant is considered a secondary source of guidance to the CPT codebook guidelines, and is published by the AMA. At the time of publication of this article, the most current CPT Assistant available on these codes was published in September 2020, so keep in mind that any other changes made to the CPT codebook guidelines in 2021 might not be reflected in the following statement (emphasis added):
What is the CPT codebook for 2021?
The official 2021 CPT codebook guidelines indicate that an extensive record review related to an E/M service that has or will occur may qualify for reporting these prolonged code. It states:
What is the extended service code 99358?
Prolonged service code 99358 may be reported for work that correlates with an E/M encounter from another date, including 99202 - 99215 when the original E/M service code was determined based on MDM instead of time. As a stand-alone-code, 99358 is based on time spent performing the prolonged service, unrelated to the time spent performing the related E/M encounter. For example, if on Tuesday the provider documented data that supports an MDM level 99213 (not based on time) and on Wednesday, the provider finally receives the medical records for the patient he saw the day before and spends 47 minutes reviewing and summarizing them, the codes reported would be 99213 for Tuesday and 99358 for Wednesday.
How many days prior to a CPT visit?
The Research Subcommittee approved the use of three days prior and seven days following the office visits based on instructions within CPT to not report certain non-face-to-face services that relate to office visit pre/post work (e.g., telephone services and inter-professional consultations).
How long is the 99358?
Report 99358 for the first hour of prolonged service time once a minimum of 30 minutes has been completed. For prolonged services that extend beyond one hour, add-on code 99359 may be reported for each additional 15-30 minutes beyond the first hour.
What is the difference between CPT 99358 and 99359?
To begin with, both codes have strictly-defined time components, meaning that the provider must meet over half of the specified time before reporting these codes. CPT Code 99358 is for the first hour of non-face-to-face services and may be billed before or after direct patient care. CPT 99359 is an add-on code, only billable in conjunction with 99358. So in the case of these codes, a provider must spend 31 minutes or more before billing code 99358, and 76 minutes or more before adding code 99359.
How many points are in CPT 99358?
In checklist form, the adopted CPT guidelines for reporting codes 99358 and 99359 consists of 5 points:
What modifiers are used to report additional services units that exceed the MUE?
Medicare allows exceptions to these MUEs. Providers may report medically reasonable and necessary units of service in excess of the MUE value assigned by Medicare. CPT modifiers such as 76 (repeat procedure by same physician), 77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), 91 (repeat clinical diagnostic laboratory test), and 59 (distinct procedural service) can be used to report additional services units that exceed the MUE value assigned to a service code. Modifier 59 may also be utilized only if no other appropriate modifier describes the service.
What is a MUE for CPT 99359?
The number of units for CPT 99359 is limited by Medicare’s Medically Unlikely Edits (MUEs) as published on the CMS website. An MUE for a HCPCS or CPT Code denotes the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
What is the CPT code for non-face-to-face prolonged services?
Perhaps the most intriguing was the introduction of CPT codes 99358 and 99359 as reimbursable codes for non-face-to-face prolonged services, such as record review.
When did the NCCI change to 99359?
Major NCCI Changes to CPT Code 99359 - on or after April 1, 2017 providers will be reimbursed for a maximum of one unit of 99358 and two units of 99359 of non-face-to-face time per patient on any given day. Previously, no limit existed for the amount of non-face-to-face time.
Can a provider use a record review code?
In the case of a record review, the provider must review the records in question. Of course, providers may only use these codes for record review when a different service provider created those records. Non-face-to-face prolonged service may not be reported for review of a provider’s own records.
What is a 99358?
99358 Prolonged evaluation and management service before and/or after direct patient care; first hour
Can you report 99202-99215 on the same day?
Beginning in 2021, you may not report these services on the same day as codes 99202-99215, office visit codes.
Is there a telephone code in CPT?
My answer to this question has always been a qualified no. I based my opinion on the examples given by both CMS (in their Final Rule) and CPT ® (in the CPT Changes: 2010 An Insider’s View) during the year these codes were developed and recognized. And, the fact that there are telephone codes in CPT. Before the pandemic the phone codes had a status indicator of noncovered, and CMS intends to assign that status indicator to those codes after the pandemic ends.
What is the code for time spent after direct face to face contact?
Another important thing to remember when using this code is the following language from CPT:#N#"Time spent after direct face-to-face contact beyond the usual not necessarily on the same date of service."#N#If the service you are billing for is a typical on, then an E/M is probably the best choice.
Is E&M 99358 a stand alone service?
Reviewing old records and studies is generally considered part of the E&M. 99358 is a stand alone service now, it use to be an add on code. Also it is timed and documentation must support a minimum of 30 minutes spent in the record review or study review.
What is a 99354-99357?
Prolonged Service with Direct Patient Contact (99354-99357) Direct patient contact is Face-to-Face (F2F) and includes additional non-F2F services on the floor/unit in hospital or nursing facility during the same session. Reported in addition to the primary procedure.
What is the CPT code for a rest home care visit?
A physician performed a visit that met the definition of a domiciliary, rest home care visit CPT code 99327 and the total duration of the direct F2F contact (including the visit) was 140 minutes. The physician bills CPT codes 99327, 99 354, and one unit of code 99355. EXAMPLE 3.
What is the CPT code for a physician's office visit?
A physician performed a visit that met the definition of an office visit CPT code 99213 and the total duration of the direct F2F services (including the visit) was 65 minutes. The physician bills CPT code 99213 and one unit of code 99354.
How long is a 99213 visit?
A physician performed a visit that met the definition of code 99213 and, while the patient was in the office receiving treatment for 4 hours, the total duration of the direct F2F service of the physician was 40 minutes.
What is the CPT code for a physician who performed an office visit to an established patient?
The physician bills CPT code 99215 and one unit of code 99354.
What is the code for extended service?
You may use code 99355 or 99357 to report each additional 30 minutes beyond the first hour of prolonged services, based on the place of service. These codes may be used to report the final 15 – 30 minutes of prolonged service on a given date, if not otherwise billed. 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
How long is 99214?
The physician cannot code 99214, which has a typical time of 25 minutes, and one unit of code 99354. The physician must bill the highest level code in the code family (99215 which has 40 minutes typical/average time units associated with it).
