Prolonged care

Good afternoon.

Can non face-to-face prolonged CPT 99358 be billed as a shared visit in the hospital setting? Any reference articles would be appreciated. I find where critical care cannot be but nothing about this code.

Thank you.


Lisa Hook, CPC, LPN
Sherry Evans, CMC

Comments

  • Per CMS manual, chapter 12

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf



    http://www.acphospitalist.org/archives/2016/04/coding-split-shared-services.htm





    H. Split/Shared E/M Visit
    A split/shared E/M visit cannot be reported in the SNF/NF setting. A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, exam or medical decision making key components of an E/M service. The physician and the qualified NPP must be in the same group practice or be employed by the same employer. The split/shared E/M visit applies only to selected E/M visits and settings (i.e., hospital inpatient, hospital outpatient, hospital observation, emergency department, hospital discharge, office and non facility clinic visits, and prolonged visits associated with these E/M visit codes). The split/shared E/M policy does not apply to critical care services or procedures.?



    Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P


    Main: 513-771-7070
    Direct: 513-672-4363

    Fax: 513-326-7640

    200 Northland Blvd

    Cincinnati, OH 45246

    mlewis@scrogginsgrear.com

    www.scrogginsgrear.com



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