For patients newly referred to a specialty practice, Advanced Practice Providers (qualified health care professionals) perform extensive medical record reviews to determine how quickly the patients should be seen and by which subspecialty in the practice. A review of all records is conducted and summarized (placing note in chart). Is it appropriate to bill 99358 for this scenario? If the patient is not subsequently seen by anyone in the practice 99358 is not submitted because there is no provider service to which it would relate for ongoing management. ...
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Article Overview
This article discusses coding considerations for advanced practice providers and qualified health care professionals who review medical records for newly referred patients in a specialty practice. It explains the general reporting context for prolonged evaluation and management services tied to pre-visit or post-visit work and highlights when that type of service is, or is not, associated with a later provider encounter. The content is relevant to coding, compliance, and charge capture staff who handle outpatient specialty practice documentation and E/M-related reporting.
Why This Topic Matters
It helps readers understand the reporting framework for prolonged pre-visit or post-visit work in a specialty setting and whether such work can stand alone or must relate to a subsequent provider service.
What You Will Learn
- How prolonged non-face-to-face E/M services are discussed in relation to pre-visit records review
- How specialty practice workflow and subsequent patient encounters affect reporting considerations
- What general documentation context is described for advanced practice provider chart review in a referral setting
- When the article indicates the service is tied to ongoing management versus not reported as a standalone event
Who Should Read This
- Medical coders
- Coding compliance staff
- Billing specialists
- Advanced practice providers
- Practice managers
- Revenue cycle teams
Codes Discussed
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