CPT & Resource Notebook

Transcription

1 CPT & Resource Notebook Newly Payable Workers Compensation Codes for Non-Face-to-Face Service Sarah Moray

2 CPT / Resource Notebook Introduction Here s a simple fact: Some patients require additional non-face-to-face care, and their providers deserve to be paid for that care. Medicare now acknowledges this. The introduction of CPTs and as reimbursable codes on March 1, 2017, creates an opportunity for reimbursement for the additional work required for workers' comp patients. In this resource notebook, we cover how to use these CPT codes for record review and other non-face-to-face services: Prolonged evaluation and management service before and/or after direct patient care; first hour (add-on code) Each additional 30 minutes (List separately in addition to code for prolonged service) For more detailed information on these codes, watch the free companion webinar on our website. Table of Contents CPT / Resource Notebook Introduction / CPT Guidelines 2 Prolonged Service Without Direct Patient Contact Instructions 2 Time Requirements 3 Incompatible Codes 3 Reimbursement Effective 3/1/ / Time Card / Supporting Documentation 6 More at DaisyBill.com 7 CPT Codes and Resource Notebook 1

3 99358 / CPT Guidelines Per CCR and relating to the Physician and Non-Physician Fee Schedule, this billing for CPT and, if applicable, CPT 99359, is reported for a service that meets all the criteria for prolonged service without direct patient contact, as set forth in the American Medical Association s CPT 2017 Standard Edition and as detailed below. Prolonged Service Without Direct Patient Contact Instructions 1. Codes and are used when a prolonged service is provided that a. is neither i. face-to-face time in the office or outpatient setting during the same session of an evaluation and management service, nor ii. additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service, and b. is beyond the usual physician or other qualified health care professional service time. 2. Prolonged service is to be reported in relation to other physician or other qualified health care professional services, a. including evaluation and management services at any level. 3. Prolonged service may be reported on a different date than the primary service to which it is related. a. For example, extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past records. 4. However, prolonged service must relate to a. a service or patient where (face-to-face) patient care i. has occurred or ii. will occur, and b. ongoing patient management. 5. A typical time for the primary service need not be established within the CPT code set. CPT Codes and Resource Notebook 2

4 99358 / CPT Guidelines Continued Time Requirements 1. Codes and are used to report a. the total duration of non-face-to-face time spent by a physician or other qualified health care professional i. on a given date providing prolonged service, ii. even if the time spent by the physician or other qualified health care professional on that date is not continuous. 2. Code is used to report a. the first hour of prolonged service i. on a given date ii. regardless of the place of service. b. It should be used only once per date. c. Prolonged service of less than 30 minutes total duration on a given date is not separately reported. 3. Code is used to report a. each additional 30 minutes i. beyond the first hour ii. regardless of the place of service. b. It may also be used to report the final 15 to 30 minutes prolonged service on a given date. c. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately. Incompatible Codes 1. Do not report 99358, for time spent in a. care plan oversight services (99339, 99340, ), b. anticoagulant management ( ), c. medical team conferences ( ), d. on-line medical evaluations (99444), or e. other non-face-to-face services codes that have a published maximum time (eg, telephone services). 2. Do not report 99358, during the same month with Do not report 99358, when performed during the service time of codes or CPT Codes and Resource Notebook 3

5 Reimbursement Effective 3/1/2017 CPT CPT Description Unit Reimbursement Prolonged evaluation and management service before and/or after direct patient care; first hour each additional 30 minutes (List separately in addition to code for prolonged service) $ $71.96 (Use in conjunction with 99358) (Do not report 99358, during the same month with ) (Do not report 99358, when performed during the service time of codes or 99496) For complete details, please refer to one of the American Medical Association s excellent CPT 2017 codebooks. Codebooks may be purchased through the AMA website. CPT Codes and Resource Notebook 4

6 99358 / Time Card Use the table below to determine the correct units and reimbursement for prolonged non-face-to-face time. Reimbursements noted below are effective 3/1/2017 and are subject to change by the DWC. Start Hour:Minute End Hour:Minute Unit Reimbursement Units Unit Reimbursement Total Reimbursement 0 0:29 $ $0.00 $0.00 0:30 1:00 $ $0.00 $ :01 1:14 $ $0.00 $ :15 1:29 $ $71.96 $ :30 1:44 $ $71.96 $ :45 1:59 $ $ $ :00 2:14 $ $ $ :15 2:29 $ $ $ :30 2:44 $ $ $ :45 2:59 $ $ $ :00 3:14 $ $ $ :15 3:29 $ $ $ :30 3:44 $ $ $ :45 3:59 $ $ $ :00 4:14 $ $ $ :15 4:29 $ $ $ :30 4:44 $ $ $ :45 4:59 $ $ $ :00 5:14 $ $ $ :15 5:29 $ $ $ :30 5:44 $ $ $ :45 5:59 $ $ $ CPT Codes and Resource Notebook 5

7 99358 / Supporting Documentation There are no specific reporting requirements for prolonged services. Nonetheless, when prolonged services are rendered, we strongly recommend including documentation. We prepared this Sample Supporting Documentation checklist as a guide for providers. Patient Name: DOS: f : Hours : Minutes of non-face-to-face prolonged service provided that relates to (face-to-face) care that has or will occur and ongoing patient management, including one or more of the following: Reviewed records from other physicians or other health care professional services, including one or more of the following: other medical records and diagnostic / radiology study results Reviewed correspondence reviewed from one or more of the following: applicant and/or defense counsel, insurance carrier, utilization review Reviewed a job analysis, an evaluation of ergonomic status, work limitations, or work capacity Preparation of RFA requesting patient treatment Preparation of requested report Discussed patient care with employer s nurse case manager Telephone call with employer s utilization review for authorization of requested treatment Other: a CPT Codes and Resource Notebook 6

8 More at DaisyBill.com Watch our free webinar on CPTs and at If you received a printed version of this notebook, but would like a PDF version, please contact us: Sarah Moray smoray@daisybill.com CPT Codes and Resource Notebook 7