Resolved Non- F2F Prolonged Care

[AmyW_37223]

Hi -

The CPT book and Chapter 12 of the claims processing manual states for the face-to-face prolonged care codes that it must be done on the same date of service by the same provider that is billing the companion code.

However, for the non-face-to-face codes it does not clearly state that it needs to be done by the same provider. Is this because these are not add on codes?

The situation I am looking at right now is with 2 Hospitalists. Hospitalist A seen and billed for an initial hospital visit (99221) at 1am. Hospitalist B is billing for 99358 (non F2F prolonged care) at 9 am of the same day. Is this allowable?

Thank you in advance for your assistance.

 

[Darcy]

AMA Guidelines:

Codes 99358 and 99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service and is beyond the usual physician or other qualified health care professional service time.
This service is to be reported in relation to other physician or other qualified health care professional services, including evaluation and management services at any level. This prolonged service may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past records. However, it must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. A typical time for the primary service need not be established within the CPT code set.
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. Code 99358 is used to report the first hour of prolonged service on a given date regardless of the place of service. It should be used only once per date.
Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management or psychotherapy codes.

Do not report 99358, 99359 for time spent in care plan oversight services (99339, 99340, 99374-99380), home and outpatient INR monitoring (93792, 93793), medical team conferences (99366-99368), or on-line digital evaluation and management services (99421, 99422, 99423).