Another set of codes for prolonged services rendered without patient contact include two codes. Items covered by these new codes include extensive record review done either before or after a face-to-face visit, but not on the same day as a face-to-face visit. These would cover reviewing outside records that need to be incorporated into the chart.
● 99358 covers the 1st hour (>31 minutes)
● 99359 is used to report additional time in 30-minute increments
They can be used only once per day and the time documented doesn’t need to be contiguous.
For example: if a physician spends around 75 minutes over 2 days before and after a face-to-face visit reviewing previous records, reviewing labs, diagnostic results, and consultant reports, one instance of 99358 and one instance of 99359 should be placed at the conclusion of this activity. A short one- or two-sentence note should be added to the chart, documenting the total time spent and what was done.
Note: These non-face-to-face codes can’t be used if the patient is being covered by other comprehensive care-management services, such as chronic care management (CCM) or transitional care management (TCM). These are easier to bill because they don't involve creating a care plan and documenting time spent by staff over the course of a month.
Although these codes are available, not all health insurance payers will provide reimbursement, including many Medicare plans. Thus, effective use of these codes may be variable. Good contract negotiators should attempt to negotiate recognition and reimbursement for these codes since it’s unlikely any insurance plan will volunteer reimbursement for these activities unless specifically asked. Similarly, many plans that include a per-member per-month payment provision will assume these types of services will be covered in that arrangement. Many ACO’s and CPC+ plans fall into this category. While they may not reimburse these submitted codes, their use helps to document activities rendered that will be expected by these alternative payment methods.
Even if a patient’s plan doesn’t cover these non face-to-face services, family physicians should get into the habit of reporting them. Each code has associated RVUs that can help in quantifying a physician's productivity. If the plan does reimburse, each phone call or online portal management, for example, has a potential reimbursement of approximately $13-$50.