CPT code 99538 represents Prolonged evaluation and management service before and/or after direct patient care; first hour

CPT code 99354 represents Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service)

CPT code 99358 -- 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. This code is 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.

CPT code 99534 -- Because +99354 is an add–on code, payers will not reimburse you unless you report it with an appropriate primary code such as: 90837, 99201–99215, 99241–99245, 99324–99337, 99341–99350.

The time used to calculate prolonged time on a single date does not need to be continuous.

Hi Dave, 

To report cpt 99358, we need to understand what Non-face-to-face time means: This code is purely based on non face to face time.

1. Non-face-to-face time (or pre- and post-encounter time) occurs when the physician performs work related to the patient before or after the face-to-face time or floor/unit time with that patient. It includes tasks such as retrieving records and test results, arranging for further services and communicating with other health care providers and the patient outside of the face-to-face encounter or on the floor/unit. In the hospital, pre- and post-encounter time also includes such tasks as reviewing pathology and radiology findings in another part of the hospital. This is “not included in the time component described in the E/M codes. However, the pre- and post-face-to-face work associated with an encounter was included in calculating the total work of typical services in physician surveys,” according to CPT 2003.

Code 99358 is used for the first 30 minutes to an hour of service, and code 99359 is used for each additional 30 minutes or for the final 15 to 30 minutes on a given day.

 Also please go throught the link provided below.

http://www.aafp.org/fpm/2003/0600/p27.html 

To be compliant within code 99358, 30 to 74 minutes non face-to-face is required. With just 20 mins non face to face will not allow billing 99358. Secondly, this code is accompanied seeing complex patient i.e higher value E/M codes.

Code 99358 as per CPT guidelines: May be reported on a different date than the primary service to which is it related. Must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. Does not need to be continuous. Time can not be counted more than once towards the provision 99358 and any other PFS service. Report only once per date of service. Thank you.