Gastroenterology Coding Alert

Question: Our gastroenterologist had a telephone visit with a patient to refill prescriptions for the patient’s recent surgery and to help fill out disability forms, too. The provider documented the time spent with the patient as 83 minutes discussing the patient’s recovery and medication adjustments and 30 minutes helping the patient with the paperwork.

Can the provider bill for time spent with the patient?

California Subscriber

Answer: Unfortunately, the maximum time you can bill for a telephone evaluation and management (E/M) visit is 30 minutes. Therefore, you’ll assign 99443 (Telephone evaluation and management service by a physician or other qualified health care 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; 21-30 minutes of medical discussion) to report the visit.

Even though the provider spent nearly two hours on the phone with the patient, they’re not going to be able to collect reimbursement for the minutes spent past the initial half hour. “It might be pertinent to use a code such as 99080 [Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form], which is not commonly recognized by Medicare or private payers but could be a cash charge to the patient. In such circumstances the patient should be alerted beforehand about the practice’s use of the code and

expected payment before providing the service,” suggests Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist and former CPT^® Editorial Panel advisor for the American Society for Gastrointestinal Endoscopy (ASGE) in Pasadena, California.