Wiki Billing for Record Review

[kirsti.bennett@tmisportsmed.com]

I have a provider that requires an MRI be reviewed to determine if he will take on a case. Have any of you ever billed for medical records review using CPT code 99358? Have you had successful reimbursement doing so? Would we still be reimbursed if he chose not to take the case on?

 

[amyjph]

I would suggest reading the guidelines in CPT right before the 99358 & 99359 codes. There are very specific requirements to report this. Also, read the CPT definition of the code (before and/or after direct patient care)
If less than 30 minutes, it is not reportable. It has to relate to a service or patient in which face to face patient care has occurred or will occur and relate to ongoing patient management. There is a time grid following the two codes also.

Some references with info:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Prolonged-Services-Policy.pdf

https://codingintel.com/new-prolonged-service-a2/

How long does it take to review the MRI and determine? Is it really a prolonged service?

Work comp may have their own ideas about this.

There may be some options here: https://www.aan.com/siteassets/home...inistrators/practice-top-5/econsult-guide.pdf
Again, very specific requirements: "Codes do not apply if the patient is seen for a face-to-face encounter 14 days before or after consultation. Codes cannot be used for arranging transfer of care or face-to-face services.

 

[CBLENNIE]

Would we still be reimbursed if he chose not to take the case on?

If the provider never performs an E&M I would say that the provider cannot bill 99358 per the following layperson description of the code:

There may be some options here: https://www.aan.com/siteassets/home...inistrators/practice-top-5/econsult-guide.pdf
Again, very specific requirements: "Codes do not apply if the patient is seen for a face-to-face encounter 14 days before or after consultation. Codes cannot be used for arranging transfer of care or face-to-face services.

The codes in range 99446-99452 require a request for a consultation from the treating provider, additionally codes 99446-99449 it requires a verbal and written report back to the requesting provider, codes 99451-99452 only require a written report to the treating provider. According to the document linked in @amyjph response there must be consent from the patient to bill the codes:


From my interpretation of the original question, the OP's physician will only take on a patient that has had an MRI done that the physician then reviews and decides if they will take the case based on the MRI results. I don't believe that any of the codes from 99446-99452 are appropriate for this reason.