• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Pricing
  • Free Resources
    • Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • Coding Guides
    • Quick Reference Sheets
    • E/M Services
    • How Physician Services Are Paid
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
    • E/M Rules Archive
  • Webinars

February 5, 2023

Are start and stop times required for non face-to-face prolonged care services?

Question:

Regarding non face-to-face prolonged care, does Medicare require start and stop times, they way they do for prolonged face-to-face care? As long as the provider documents the total time spent reviewing old records is sufficient to bill this service, am I correct? (Codes 99358, 99359) Note, beginning 1/1/2023 these codes have an invalid status indicator for Medicare. They are still active CPT codes.

Answer:

Neither CPT® nor CMS require start and stop times.

And, from the Medicare Claims Processing Manual, 100-04, Chapter 12

30.6.15.2 – Prolonged Services Without Direct Face-to-Face Patient Contact Service (Codes 99358 – 99359) (Rev. 3678, Issued: 12-16-16, Effective: 01-01-17, Implementation: 01-03-17)

Until CY 2017, CPT® codes 99358 and 99359 were not separately payable and were bundled (included for payment) under the related face-to-face E/M service code. Practitioners were not permitted to bill the patient for services described by CPT® codes 99358 and 99359 since they are Medicare covered services and payment was included in the payment for other billable services.

Beginning in CY 2017, CPT® codes 99358 and 99359 are separately payable under the physician fee schedule. The CPT® prefatory language and reporting rules for these codes apply for Medicare billing.

For example, CPT® codes 99358 and 99359 cannot be reported during the same service period as complex chronic care management (CCM) services or transitional care management services. They are not reported for time spent in non-face-to-face care described by more specific codes having no upper time limit in the CPT® code set.

We have posted a file that notes the times assumed to be typical for purposes of PFS rate-setting. That file is available on our website under downloads for our annual regulation at http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html.

We note that while these typical times are not required to bill the displayed codes, we would expect that only time spent in excess of these times would be reported under CPT® codes 99358 and 99359.

We note that CPT® codes 99358 and 99359 can only be used to report extended qualifying time of the billing physician or other practitioner (not clinical staff).

Prolonged services cannot be reported in association with a companion E/M code that also qualifies as the initiating visit for CCM services. Practitioners should instead report the add-on code for CCM initiation, if applicable.

Change in rules for codes 99358, 99359 in 2021

These are still active codes in 2021, however, they may not be reported on the same day as office/outpatient codes 99202–92915. They may be reported on days prior to or after a visit, or on the same day as other E/M services. See the CodingIntel page on E/M Changes for 2021 for more details.

View all Everyday Coding Q&A’s

 

Get more tips and coding insights from coding expert Betsy Nicoletti.

Subscribe and receive our FREE monthly newsletter and Everyday Coding Q&A.

Sign up

We will never share your email address. Unsubscribe anytime.

Last revised December 15, 2022 - Betsy Nicoletti
Tags: level of service_time

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

Sign Up Now

2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

Watch it now

Latest Intel

Removal of sutures or staples

There are three codes for removal of sutures or … Read More...

Coding for Hernia Repair

CPT® revised the codes and concepts used for … Read More...

Coding Guide – Critical Care Services

Critical care is a complex service provided to a … Read More...

CMS Teaching Physician Rules Update | Webinar

Let's review the teaching physician … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services behavioral health_medication management care management CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding ICD-10 coding level of service_history level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers office and other E/M Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures prolonged care remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright © 2023, CodingIntel
Privacy Policy