Coding and Compliance: Report Prolonged Non-Face to Face Services Correctly

We have two codes that can be reported for prolonged non-face to face services: 99358 and 99359. These codes are non-face to face times. So for instance, the physician might be looking at extensive records that the patient had submitted to them that weren't available at the time of the visit, something like that.

AS per the recent medical coding updates, the code is taken out of add-on code status. So you don’t have to bill these. They don’t have to be attached to a timed E/M service on the same date. They do have to be attached to some E/M service, either one that took place before or a service that takes place after the non-face to face service.

And the total time of this non-face to face service has to be at least 30 minutes or more beyond what they call the usual non-face to face service of most E/M codes. Again, go back and read your medical coding guidelines in your CPT book. And it will explain to you about the usual non-face to face component that is included in every E/M code so you'll get a better feel for what they're talking about.

You can bill them on a separate date. And the time does not have to be continuous to bill for these. You would not report these prolonged physician services codes if you work or instead going to be billing for medical conferences or online medical evaluations or care plan oversight services. And the reason for that is if those codes do not have a maximum, in other words, you could bill these codes whether it took you ten hours or two minutes, all right.

But you can bill them with telephone services because with telephone services, you have a distinct number of minutes that you're talking to the patient and you could have exceeded that. And so, you could use the prolonged services code for that reason.

So if the patient again, is kind of like the other prolonged services codes, if you exceed the additional time less than a 15 minutes increment, then you don’t go on and report the next (entire) code. So if the patient is seen for one hour and 14 minutes, you'd bill 99358. And if the patient is seen for one hour and 44 minutes, you would bill 99358 and 99359.

So again, the medical coding rule for these codes hasn't changed all that much. It's just that they're not add-ons anymore. So you may have better opportunity to use them.

49411: A Catch-All Code

A new code was introduced as per the new medical coding guidelines, a 49411. This is reported for markers. Now, generally speaking, this means things that they put in so that when they do radiation therapy, they can zero in on the marker and put the beam exactly where it needs to be. So it places, it allows the placement of the beam carefully in the tissue that needs to be eradiated. And that's the purpose of it.

This is a catch-all code. It means you can use it for many different approaches. It can be percutaneous which means you took a needle. You shot the seeds into the body, that way. It could mean intraabdominal which means you could have made an incision and placed them into the intraabdominal cavity.

Retroperitoneal of course is somewhere near the bladder. And intrapelvic is usually the organs within the pelvis including the uterus. This code could be used for placement of gold seeds into the cervix because it's typically meaning this is how it could be used. This would be a good code for that since we don’t really have anything that specific for cervical placement right now.

The intent of that code is there so that it would safe to use this one. And if imaging guidance were used in addition to placing the seeds, then you would also bill 76942 as your secondary code.

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