Awareness : OBC Tips

Prolonged Services (Codes 99354-99359)

CMS issued an edit for 99358 & 99359, which went into effect on April 1, 2017. The updates to the sections which address prolonged services codes include consistency with changes/deletion in codes and changes in typical/average time units in the American Medical Association Current Terminology Procedural Terminology (CPT) coding system. You will only be able to claim two units of the add-on code 99359 per day, since you add 99359 onto 99358 after the first hour, that only allows for a maximum of two hours of reportable time on the claim.

Documentation is required to be in the medical record about the duration and content of the medically necessary evaluation and management service and prolonged services that is billed. These new CMS time thresholds are aimed to holding providers accountable to the medical necessity of the prolonged care.

You can only bill the prolonged services codes if the total duration of all physician or qualified NPP direct face-to-face service (including the visit) equals or exceeds the threshold time for the evaluation and management service the physician or qualified NPP provided (typical/average time associated with the CPT E/M code plus 30 minutes).