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David Posted Thu 26th of February, 2015 16:45:23 PM

In NY for a Workers' Compensation patient you must provide objective functional testing to document positive patient response. I use an independent company to fulfill the objectivity requirement. The functional company sends to my office a Technologist (MD, DC, or PT) to perform the functional assessment and provides back to me a 24 page report of the findings. It takes me approximately 40 minutes to review/analyze/interpret the report. My question is should I bill out (1)99212 for my initial exam, note the need for functional testing. (2)Bill 99358 for the time I spend reviewing/analyzing/interpreting the report. (3)Bill 99212 again afterwards when I consult the patient.

99212 Initial Exam
99358 Review Report
99212 Consult Patient

SuperCoder Answered Fri 27th of February, 2015 08:56:16 AM

Hi Dave,

Thank you for the query.

Yes, you can bill CPT 99212 for Initial examination along with 99358 for reviewing report. Please do not forget to mention the total time spent along with the physician face to face time spent.

You cannot bill CPT 99212 for consulting the patient again, as the E/M service is performed on the same day, by the same provider, and the consultation service is like a follow-up of the functional assessment performed.

David Posted Sat 21st of March, 2015 11:50:00 AM

For the work I am doing is 99358 the correct code?

SuperCoder Answered Wed 25th of March, 2015 07:06:49 AM

Yes, 99358 is the correct code for prolonged evaluation and management service before and/or after direct patient care; first hour without direct patient contact.

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