Faculty Group Practice Newsletter

    99358 – Prolonged E/M before and or after direct patient care; first hour (30 to 74 min) 

+ 99359 – Each additional 30 minutes (must have at least 75 minutes) 

May Not bill these codes on the same date as another Evaluation and Management Service. Medicaid will pay for these codes, Medicare does not.  Clinics should verify benefits for all payors and inform the patient of their financial responsibility. 

These codes are used for extensive time in addition to seeing the patient and must relate to a service for a patient where direct face-to-face patient care has occurred or will occur and be part of ongoing patient management. The time spent for prolonged non-face-to-face services does not need to be continuous but must be on the same calendar date.  Only faculty or APPs' time will count.  Do not bill on the same date as another E/M. 

Examples and Required Documentation:

• Review of records from previous provider 
  • Date of service this work relates to. This will be a previous or a future visit. 
  • Brief narrative of which records reviewed along with pertinent information that relates to the prior or future date of service. 
  • Time spent on this visit 
• Behavioral Health – review of records/school forms, etc.  
  • Date of service this work relates to. This will be a previous or future date. 
  • Summary of the work done to justify this service 
  • Time spent on the visit 
• Peer to Peer Review – related to management of the patient 
  • Records reviewed to prepare for the phone call 
  • Summary of the phone call  
  • Time spent on the visit  
• Call to the patient initiated by the provider concerning coordination of care or ongoing management of care 
  • Date of service this relates to 
  • Ongoing management or coordination of care 
  • Summary of the phone call  
  • Time spent on the visit  
• Conversations with other providers concerning patient management 
  • Conversation with the other provider 
  • Decision concerning the management of the patient 
  • Date of service this relates to 
  • Time spent on this visit