Paul G. Auwaerter, MD


January 02, 2018

Hello. I'm Paul Auwaerter with Medscape Infectious Diseases, speaking from the Johns Hopkins University School of Medicine.

As infectious diseases clinicians, many of us in the field have long thought that we've done a fair amount of work of an uncompensated nature, in doing what's best for our patients. It's been hard, at times, to convince others, especially those who set professional fees or help administer healthcare organizations or insurance companies in the executive suites, of the value of an infectious diseases specialist and the care that we render.

Over the years in the fee-for-service environment, procedural specialties have tended to be overvalued to some degree compared with cognitive specialties, which have received more recognition. Articles authored by those of us in the infectious diseases field have tried to point out the value that we provide in diverse settings including: consultative care in hospitals, outpatient parenteral antibiotic therapy, treatment of Staphylococcus aureus infection, HIV care, and assessing outbreaks of infectious diseases.[1,2,3,4,5]

A notable change occurred this year that I hope might increase the recognition of the value of cognitive work that is not carried out in direct patient care. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued a new set of codes for payment of prolonged services without direct face-to-face patient contact by any of the federal programs.

This is potentially transformative, at least for the longer periods of work we do. But at ID Week in October, I was surprised that a fair percentage of people practicing in the field were not yet aware of the new codes.

In the reference list, I've given a couple of website links[6,7] that talk about these Current Procedural Terminology (CPT) codes—99358 and 99359—that can be used for payment for service either before or after a direct care episode. At the moment, as far as I know, only CMS and federal insurance recognize these codes and remit payment. I'm hoping that this will then spread elsewhere.

I'll give you a couple of examples of prolonged services. Earlier this month, I reviewed 440 pages covering 3 years of clinical care for a patient who had suspected Lyme disease. Before now, I would have to somehow do that on the side. In this case, I can bill for this time. You can't bill for anything less than 30 minutes. These codes work much like those for direct, prolonged services, where you can bill for the first hour and then in increments of 30 minutes.

Another case was a patient for whom I did prolonged work over the course of a day. It was a complex patient with disseminated bacillus Calmette-Guérin infection, and the case required discussions with the laboratory, long telephone discussions with the patient and his wife, as well as the surgeon, directing antibiotic management, and so on. I was able to bill for this under the new code set.

You may want to take a look at this and incorporate it into your practice, as it can provide some benefit. It helps us do a better job caring for patients if we're actually recognized for some of this work that we do, whether it's part of case management or doing our best to understand a patient's problems and the care they've received. Thanks very much for listening.


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