With the future of healthcare remaining uncertain, the likely repeal of the Affordable Healthcare Act and resultant Medicare and Medicaid budget cuts, it is important to note some of the newer Current Procedural Terminology (CPT) codes that are being reimbursed by Medicare and other insurers. These codes provide reimbursement for many of the time consuming endeavors that we perform every day in our post-acute and long term care practices but have previously gone uncompensated.
Two of the more significant codes for our practices are 99358 and 99359 which encompass Non Face-to-Face prolonged services. Traditionally, Medicare and other payers would only compensate physicians for “face-to-face” encounters for a patient. It has now been recognized that physicians and mid-level providers often spend significant amounts of time reviewing records, consulting with other physicians, coordinating care, etc. that overall improves the care of a patient and may reduce hospitalizations but has not previously been adequately performed because of lack of reimbursement. Starting January 1, 2017, code 99358- prolonged evaluation and management service before and/or after direct patient care, first hour and 99359 – each additional 30 minutes will be reimbursed by Medicare at $113.41 and $54.55 respectively (100% of fee with usual practices regarding deductibles and copays applying). Important rules regarding these services are as follows:
- This service may be provided on the same day or on a different day than the face-to-face service.
- It is for extensive time in addition to seeing the patient, and must relate to a service for a patient where direct face-to-face patient care has occurred or will occur and be part of ongoing patient management.
- Code 99358 is not necessarily an add-on code. That is, it can be reported on the day when no other service is provided.
- Code 99359 is an add-on code to code 99358.
- The time during the day of a non-face-to-face service does not need to be continuous.
- CPT indicates not to report these services during the same month as complex chronic care management (99487, 99489) or during the service time of transitional care management (99495, 99496)
CPT rules for services related to time are in effect. For a service defined with a time component, the clinician must meet over half of the time stated. In the case of these non-face-to-face prolonged services, that means that 99358 maybe reported when 31 minutes or more have been spent and 99359 when 76 minutes or more have been spent.
Future articles will review chronic care management and advance care planning codes.
David Siskind, MD, CMD