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Billing and Finance

Next Reply: Re:99356
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Post 99356
Author: Lustbader
Date: Jul 9, 2010 12:00 pm
CMS recently performed an audit of the prolonged services codes for "face to face" time. Out of about 11,000 bills submitted with prolonged service code, payment was denied in 94% of the cases in NY and CT. Denial was based on discussion with family member rather than patient (i.e. patient comatose), lack of time in and time out, or unclear signature. It is getting harder to get paid for what we do. I was denied 140 out of my 140 99356 during this audit.
Dana
Replies: order by [Date] [Author] [Subject]
Re:99356 (by dianeemeier on 07/09/2010)
Hi Dana- thanks for promoting awareness of this important issue. The Academy (AAHPM) is actively working on a solution with a lobbying group who has expertise in the coding and billing side of Medicare.Once we know what the plan is we'll post it. Letus know if you or anyone else reading this have insight or ideas on how to gat this corrected. Diane Meier
Re:99356 (by JulieP on 07/12/2010)
Medicare requires you to be face-to-face with the patient which is the opposite of what their critical care policy allows. Your notes should clearly indicate what time was face-to-face and what time was non face-to-face and you can only bill CMS for the amount that was F2F using CPT 99356. Non F2F time is billed using 99358, which CMS will not reimburse. The documentation has to be very clear regarding time spent, was patient included and what was discussed. It's painful, but if you can document and bill accordinlgy you should have any problems in an audit.
Julie Pipke-CPC, CAPC

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