CPT 2010 Update: Non-Face-to-Face Prolonged Services

New Year’s hats & horns for looser guidelines that let you count work spread over days.

Groaning thinking of all the time you’ll never capture for complex cases requiring extensive pre-visit time? CPT 2010 brings you hope.

Extensive guideline revisions “liberalize prolonged non-face-to-face services codes,” reports Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. “This CPT change is a really good one.”

Think 99358, +99359 on Non-E/M Day

For 2010, you can count indirect prolonged service time that occurs around the date of the E/M service. “Under the old definition, the non-face-to-face service has to be the day of the E/M,” Tuck explains.

Be careful: Prolonged service codes 99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; first hour) and +99359 (… each additional 30 minutes [List separately in addition to code for prolonged physician service]) still have to relate to an E/M service that involves patient contact. The prolonged service “must relate to a service or patient where direct [face-to-face] patient care has occurred or will occur and relate to ongoing patient management,” according to the revised notes. CPT places no timeframe on the time that can elapse between the primary service and prolonged service.

“The loosening of prolonged non-face-to-face service code is going to be a great help if you’re going to see a complex child,” Tuck says. You can look at the patient’s chart and make phone calls before seeing the patient and count that time. Here’s a good clinical example from Tuck:

“I saw a baby with Down’s syndrome with heart failure and home nursing. I spent a lot of time over several days reviewing the patient’s chart and making phone calls to coordinate his subspecialty care. Under the current 2009 non-face-to-face guidelines that were effective at the time of this encounter, I could code only 99205 (Office or other outpatient visit for the evaluation and management of a new patient … Physicians typically spend 60 minutes face-to-face with the patient and/or family) and 99358 for the first hour of non-face-to-face prolonged service that I performed on the same day. I couldn’t report the work I had done earlier that week.”

In 2010, Tuck could tally each day’s non-prolonged service time and report the applicable time-based code(s). The time does not have to be continuous, according to the revised guidelines. The codes’ descriptors remain the same.

By Jennifer Godreau. © Pediatric Coding Alert. Download your 2 Free Sample Issues here.

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