EM Coding Alert

Question:  A patient leaves a message seven days after the previous related E/M visit and wants phone care. Because the caller left the message on the office machine on a Sunday, we did not get the message until day eight. Can we bill for that phone call? Also, can I use a phone care code for a call that a physician makes to the emergency department (ED)?

Codify Subscriber

Answer: In scenario one, you can report the phone call eight days after the related E/M service with the phone care codes (99441-99443, Telephone evaluation and management service provided by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment …). Include related phone care that a physician provides to a patient/ family member within seven days of the related E/M service.

Beware: Make sure you are not gaming the system by intentionally responding outside the time frame. As you indicate, you could not respond to the call within the seven days because you received the request when the office was closed.

Your second question hits on another phone care requirement. A 99441-99443 call must be from a physician to a patient/family member. A physician-to-physician call could count under care plan oversight if the patient is under a home health agency (99374-99375) or is receiving hospice care (99377-99378). No real option exists for a call from an office physician to an ED physician. Consider the call part of the related E/M service that the physician may provide.