Two little-known CPT codes were added in 2017 that I’d like to bring to your attention. These are codes used for care that occurs before or after face-to-face encounters, and can be used to help compensate for care delivered to complex patients or during periods of complex case management.
99358 Prolonged evaluation and management service before and/or after direct patient care; first hour
99359 Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes (list separately in addition to code for prolonged service)
Both of these codes can be billed prior to, or following, a related, face-to-face encounter with the patient; and can be billed on the same day as the related E/M service (99201-99205, 99211-99215) or on a separate date of service after in-person care was rendered.
In order to effectively chart your note, you must document how much time was spent on the service. This amount must exceed 30 minutes (“31 minutes spent”) in order to bill the 99358 and the time spent must be aggregated on one date of service.
Covered services include:
- Extensive medical record review or diagnostic study review
- Extensive telephone calls with patient, parent or guardian
- Meetings with family or caregiver without the patient
Note: You cannot use these codes for non-clinical intervention, documentation of medical records, forms or letters, and they cannot be billed by clinical staff without the presence of the billing provider.
You can access more information about these codes here:
NGS Prolonged Services
NGS Prolonged Services FAQs
And as always, check with your local payers to see how they are covering these services and if they are separately payable.