Gastroenterology Coding Alert

Phone consults could earn you as much as $25.48 from payers, except Medicare.

Physicians and their patients spend more and more time on the phone for consultations these days, but is this service a no-no? If you're asking whether or not you can make money out of this service, the answer is yes. Then again, just like other consultation codes, you have to stick to some guidelines.

Downside: Medicare will not pay for patient consultations performed over the phone. Other payers may, however, so you will have to check with them on a case-by-case basis.

When you bill for telephone services, you would typically do so using two sets of codes: 99441 -- 99443 (Non-face-to-face physician telephone services), which are for phone services by physicians; and 98966 -- 98968 (Non-face-to-face nonphysician telephone services), which are for services by "qualified non-physician healthcare professionals."

These code sets debuted in 2008, and replaced the complexity-based telephone call codes (99371-99373, Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...).

Some payers are actually agreeing to pay for it, said Penny Noyes, president and CEO of Health Business Navigators in Bowling Green, Ky., in an article "How To Get Paid For Care Delivered Over The Phone" on amednews.com (American Medical News) published on Feb. 1, 2010.

If you find phone consultations becoming a real issue for your practice, you should consider billing these services, provided you adhere to these rules:

• Bill these codes only for the purpose of medical discussion not related to an E/M service that was provided within the last seven days and does not lead to an office visit within the next 24 hours or earliest possible date.
• Make sure the provider who took the call document the phone conversation. Document it like an in-person visit, with particular notation of the time spent, says the amednews.com article.
• Take note of the existing fee schedule for these codes and use them to determine what fee you will charge your patients for these codes. Although Medicare does not pay for these codes, you can expect to be paid the following figures:
• $8.49 for 99441and 98966 (0.41 nonfacility RVUs multiplied by the 2011 conversion rate of 33.9764)
• $16.99 for 99442 and 98967 (0.78 nonfacility RVUs multiplied by the 2011 conversion rate of 33.9764)
• $25.48 for 99443 and 98968 (1.15 nonfacility RVUs multiplied by the 2011 conversion rate of 33.9764).
• Don't forget that the patient must initiate the call in order for you to bill the service.
• Limit the coverage of these services for established patients only.

Example: An established patient with a history of heartburn leading to GERD calls his gastroenterologist to discuss new acute GERD (530.81, Esophageal reflux) symptoms. The nurse takes a history via telephone, assesses the patient's condition, and talks to the gastroenterologist, who decides to prescribe an antibiotic. The nurse-to-patient call lasts 18 minutes.

You would report this with 98967 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion) based on time and personnel, rather than on complexity. However, if an appointment is scheduled to evaluate the patient before treatment is determined, you should not report this code.

Bottom line: If you haven't started billing these telephone services, and would like to start doing it, it would be better to inform your patients ahead of time in order to clear the air and avoid confusion. Aside from telling your established patients that you would be charging for phone consultations, you should also specify what the charge is, and what the parameters are for the charges.