General Surgery Coding Alert

Question: I-ve been advised in the past that I cannot be paid for time the physician spends with a patient on the telephone. Is this true? Can we report these services separately or, if not, can we factor them into other services the physician provides?


Tennessee Subscriber

Answer: CPT offers three codes for telephone services (99371-99373, Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists] ...), but you shouldn't expect to get paid for them.

Most insurers consider these types of telephone calls (which are not -face-to-face- services) part of your physician's business tasks, and therefore will not reimburse for them. Medicare, for instance, has never paid on these codes, and there are no published relative value units for 99371-99373.

Tip: Occasionally, some private payers will pay on these codes, so you can try reporting them and see if the carrier pays you. Some Blue Cross/Blue Shield plans are paying for after-hours calls. For instance, Blue Cross/Blue Shield of California pays $18 for a level-two call (99372).

The good news: Just because your payer doesn't recognize 99371-99373 doesn't mean that the physician's time isn't reimbursable

The most widely recommended option is to apply the time and effort spent on the telephone call when deciding the appropriate E/M service level for the patient's next visit. Telephone calls are inclusive in the payment for the E/M pre- or postservice work. If documented appropriately, you can receive credit in the amount and complexity of data in medical decision-making.

And although phone time won't necessarily increase the level of E/M service, phone calls -- especially consultations with other physicians -- can assist in boosting the level of medical decision-making (MDM) for the patient's next visit.

Pointer: If you choose to apply the time to the MDM, be sure your physician documents the phone conversation in the office note, wrapping it into the next visit. 

Bottom line: You should usually bundle phone calls into the E/M visit without any effect on the service level you-ll choose. You should look for specific signs that a phone call was significant and should count toward the next E/M visit. These include:

- the decision for more treatment after the phone call

- a prescription (or even a refill) or a dosage change over the phone

- a discussion of new symptoms

- the decision that a condition is worsening or a new condition has been added

- informative chats with family members and previous providers.

Any of those factors would increase the MDM's complexity at the next visit when wrapped into the context of that visit's MDM.