Prolonged Services and nursing home visits.
I’m getting a “Code 99358 is a column 2 code for 99309, these codes cannot be billed together in any circumstance” error from our scrubber when we try to bill CPT 99358 and 99309 on the same date of service.
I thought these were billable with other E/M’s and I’m unable to find any rationale behind the bundling edit. We have a doctor that does not believe the edit is legitimate and I am at a loss. Can you help?
Updated March 2, 2018
99304—99318 Nursing facility codes
99358—99359 Prolonged evaluation and management services (without face-to-face contact)
This seemed wrong to me. However, I keep hearing that these are denied, and that NCCI edits allow them both to be billed on the hospital side but not the professional component. That makes no sense to me.
I went back and looked at the CPT book, at CPT Changes 2010, an Insider’s View and CPT Changes 2012, an Insider’s View, and at the 2017 Physician Final Rule that discussed that Medicare was changing the status indicator for 99358 and 99359 to active.
I can’t see anything from CMS or CPT that would indicate that nursing facility codes should be treated any differently than any other E/M service. There isn’t a similar edit in place for inpatient or observation status codes.
CPT does say you can’t report these codes with CCM or during the service time period of TCM. That’s all.
I’m at a loss as to “why.” There is an edit is about all I can say.
Reviewed, Betsy Nicoletti 10/12/2018become a member. Already a member? Login