Forum - Questions & Answers
Non face-to-face proglonged services
Hello- I work for a HemOnc office and we have a situation where the patient was seen a couple days ago, then the family came in, without the patient to discuss treatment/prognosis with the physician. The doc spent approx 45mins with the family. I want to know if anyone has any suggestions on how to bill this. Per the CPT book they have the codes 99358 and 99359- from my understanding if the doctor does 45mins in one day (which is our situtaion) we can add this on to the E&M we billed 3 days prior? It is one instance, we are billing only one service but it wasn't continuous? Does this make sense? Anyone have any ideas??
Out of luck
Without the patient present, the service is bundled into the last E&M. You can't go back and add it to the previous visit.
Be sure your docs are aware fo the prolonged services codes 99354 to 99357. For example can code a 99213 and a 99354 if the doc spend 45 minutes with the patient to discuss colon cancer treatment, rather than billing a 99215.
too bad!
Ok- well thank you anyway! I pretty much thought I would be out of luck, but thought I would try! Have a great day : )
wondering the same
Is this also true of Pedi patients if the parents come in to discuss behavior issues without the child present?
wondering the same
The CPT book does describe E/M services as with the "patient and/or family." Medicare has specifically said that without the beneficiary present, it is not a billable service. It is part of the pre and post work to other services.
Other payers may follow CPT rules rather than CMS rules, and allow you to bill the insurance company for the service. You need to check with them. There is also a V code to indicate that the person consulting you is not the patient.
Non face-to-face prolonged services
There is an article in Codapedia about prolonged services, a general discussion, that quotes the Medicare manual about this.
Although other insurances aren't required to follow Medicare rules, many of them have adopted the policies in the Medicare Fee Schedule, and the status indicators.
