AMA CPT® Assistant - 2012 Issue 8 (August)
Prolonged Evaluation and Management Services (99354-99359) (August 2012)
August 2012 pages 3-5 Prolonged Evaluation and Management Services (99354-99359) Two significant editorial changes have been made to the Prolonged Service With Direct Patient Contact guidelines for the CPT 2012 codebook. The first change omits the reference to "face-to-face" for direct patient contact prolonged services codes 99354-99357. The second change includes the removal of physician-specific references in the title and code descriptors of codes 99354-99359. This article will provide the rationale for these changes, clarify the intent and use of prolonged services with and without direct patient contact, and update two specific reporting instructions related to codes 99358 and...
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Article Overview
This article explains August 2012 CPT Assistant updates related to prolonged evaluation and management services. It covers editorial revisions to prolonged service guidelines, distinctions between services with and without direct patient contact, reporting context across outpatient and inpatient settings, and the broader CPT policy basis for removing physician-specific language. The piece is useful for coders, auditors, compliance staff, and clinical documentation teams who work with CPT E/M reporting guidance.
Why This Topic Matters
Accurate understanding of prolonged service guidance affects how CPT E/M services are documented and reported, especially when service time, setting, and provider terminology are involved. The article also clarifies how CPT editorial updates align with broader code-set neutrality and reporting conventions.
Article Sections
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August 2012 pages 3-5
Publication placement information for the article.
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Overview of Code Structure
Introduces the organization of the prolonged service code group and the distinction between direct and non-direct patient contact services.
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Prolonged Service With Direct Patient Contact (99354-99357)
Discusses the direct patient contact prolonged service category and related editorial updates in the CPT 2012 codebook.
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Prolonged Service Without Direct Patient Contact (99358 and 99359)
Covers the non-direct patient contact prolonged service category and the related reporting guidance updates.
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Coding Tip
Highlights a brief reporting note included in the article.
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Prolonged Service (Physician or Other Qualified Health Care Professional)
Explains the broader CPT terminology change and the code set’s approach to practitioner designation and neutrality.
What You Will Learn
- How CPT structures prolonged evaluation and management services into direct and non-direct patient contact categories
- What general types of editorial changes were made to prolonged service guidance in CPT 2012
- How prolonged service reporting differs by setting and timing context
- Why CPT terminology may be revised to reflect broader practitioner language
- How the article frames prolonged services within the CPT code set’s neutrality principles
Who Should Read This
- CPT coders
- Medical billing staff
- Compliance professionals
- Auditors
- Clinical documentation specialists
- Practice managers
- Physician and nonphysician provider offices
Codes Discussed
Code Ranges Discussed
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