Anesthesia Coding Alert

Question: Which code(s) should I use for a workers compensation phone hearing in which my physician participated? The phone call was between the patients caseworker and the doctor. We are still treating the injured worker.

North Carolina Subscriber

 
Answer: The procedure codes may depend on the complexity of the call. These codes are as follows:

99371 Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals simple or brief

99372 intermediate

99373 complex or lengthy .

 
Medicare will not normally reimburse for these procedures. However, most workers compensation (WC) carriers will, under the right circumstances. For example, a WC carrier in Florida assigns a time factor of less than 10 minutes to 99371 and does not reimburse for the physicians services. Code 99372 is assigned a time factor of 10 to 15 minutes, and reimbursement is $17. For 99373, the assigned time factor is 16 minutes or more, and reimbursement is $22. Most carriers will not reimburse for phone charges.
 
Some carriers may prefer 99499 (Unlisted E/M service). The claim must also include an appropriate diagnosis code and an E code to describe the injury or accident.
 
CPTs description of these codes is quite long. Coders should review the criteria for using these codes in both the CPT and WC manual for their state. Also check with the patient-specific WC carrier to determine its reimbursement policy for these procedures.