Gastroenterology Coding Alert

Great news: For those gastroenterologists spending more time with patients on the phone or online, CPT 2008 has developed some new codes that may get you paid.

Benefit: Although payers may not reimburse these new codes, they will allow physicians to bill the patient for these services in many instances and help the practice "better track the care being given by office providers," says Jennifer L. Lawrence, CPC, coder and billing manager of Westside Gastroenterologists Inc. in Middleburg Heights, Ohio.

Deletion: When you report 99371-99373, you are saying your physician called a patient or coordinated medical management with other healthcare professionals, such as nurses or other physicians. CPT 2008 deletes these codes. Instead, you've got six new codes for telephone E/M care, and the length of the call will determine which code to pick:

Notice how 99441-99443 entails telephone E/M services involving a physician while 98966-98968 involves a qualified nonphysician healthcare professional.

The nitty-gritty: Keep in mind, however, that you've got some rules to contend with. For instance, the new time-based telephone call codes will not only have a seven-day pre-global period but can also not result in an office visit within 24 hours, says national coding speaker Richard H. Tuck, MD, FAAP.

To use these codes, keep in mind the following:

• The patient or the established patient's guardian must initiate the contact.

• Do not report the new codes if your gastroenterologist sees the patient for the problem within 24 hours of the call or at the next available urgent appointment. When this happens, you should consider the call part of the preservice work and count it as part of the billable E/M service.

• Do not report the new codes if the call relates to an E/M service that the gastroenterologist provided within the previous seven days. Whether the provider requested the patient to make the call doesn't matter.

• Do not report the new codes for any follow-up regarding a procedure that your gastroenterologist performed while still in the postoperative period.

Good advice: You should include documentation of the communication within the patient's chart -- especially if you're going to bill the patient for the service. The note may include the date of the call, the length of the call, the reason for the call, and any recommendations provided to the patient.

But the big question remains: Will payment make reporting the new telephone care codes worthwhile? CMS will publish relative value units (RVUs) for possible payment of the new codes to move forward. Check future issues of Gastroenterology Coding Alert for this information.

Remember: You have stipulations in your payer contracts that you must consider prior to billing patients, says Edwina Sprow, CPC, owner and consultant for Sprow Consulting Services in Phoenix. "I suggest you first ensure that billing the patient for any services that a payer won't pay for is not in violation of your contractual agreement. Once you ensure that, then you should put a payment policy in place."

The Internet allows patients to contact their physician or nonphysician practitioner, and with the assurance of privacy that these systems provide today, the patient and physician can share information.

Change: Because CPT 2008 no longer considers e-mail services an "emerging technology" (temporary Category III codes), you'll discover two Category I codes.

In other words, you'll no longer use the 2004-created CPT Category III code (0074T, Online E/M service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient) beginning in January. Instead, you should report one of the following codes:

Note: Online E/M visits, consultations and Web-visits all fall under the term "e-visit," which is a structured non-urgent consultation between a doctor and an established patient conducted over the Internet.

Before you start reporting e-visits, you have rules you must keep in mind. The criteria for these codes are as follows:

• The established patient or her guardian must have initiated the online evaluation request.

• The provider's response must be timely and must include permanent electronic or hard-copy documentation of the encounter.

• You can report the online service only once during a seven-day period for the same issue, but more than one provider can report their separate online communication with the patient.

• As with telephone contact with the patient, do not report the new codes if the provider has billed an E/M service related to the online query within the previous seven days or within the postoperative period of a procedure.

Along with new codes for telephone and e-visits, you also have two new codes for medical team conferences.

Lowdown: The rules for medical team conference codes are somewhat different. Using an interdisciplinary team is more comprehensive and complex than the conversations that might take place during a regular E/M service.

The new codes are 99367 (Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician) and 99368 (... participation by nonphysician qualified healthcare professional).

Keep in mind, however, you have to meet certain criteria before you use these codes:

• The patient must be an established patient who has chronic or multiple health conditions that require a team approach.

• The participants in the conference must be familiar with the patient and have seen the patient within 60 days prior to the conference.

• Only one provider from the same specialty may report these codes per conference.

• The conference must be a least 30 minutes in length and starts at the beginning of the review of an individual patient and ends at the review's conclusion. You should not count time spent writing reports.