Internal Medicine Coding Alert

Question: A new patient came to our office, and our physician did a complete workup, resulting in a level-three new-patient E/M visit. Five days later, the doctor called the patient to see how he was doing, to discuss questions the patient had, and to recommend a follow-up appointment. He spent 22 minutes on the phone with the patient and wants to bill for this time. Should we report a code for the telephone service?

Delaware Subscriber

Answer: In this case, no. CPT does offer three telephone service codes:

• 99441 -- Telephone evaluation and management service provided by a physician 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; 5-10 minutes of medical discussion

• 99442 -- ... 11-20 minutes of medical discussion

• 99443 -- ... 21-30 minutes of medical discussion.

Although reporting 99443 might seem like the right choice because the physician spent 22 minutes on the phone discussing the patient's care, the code descriptors for these codes specify that you cannot report 99441-99443 within seven days of an E/M service. Therefore, you cannot bill for this telephone call. Codes 99441-99443 were established to describe a telephone service initiated by an established patient and provided by your physician. The codes represent non-face-toface E/M services provided by your physician that do not lead to a related office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).

Furthermore, you cannot report a telephone E/M service if the call is in reference to a specific procedure and the call occurs within the postoperative period of that procedure.

If your physician's telephone service ends with a decision to see the patient within 24 hours -- or the next available urgent visit appointment -- do not report a telephone service code. In this event, the phone encounter is considered part of the preservice work of the subsequent E/M service, procedure, and visit.

Caution: The telephone E/M service codes also cannot be reported if another telephone or online E/M service has been reported in the previous seven days.

Example: In this scenario from CPT Assistant, March 2008, you could report a phone service:

An established patient calls your internist with a new complaint. Your internist obtains a brief history, asks about the patient's current medication use, and makes treatment recommendations. All this information is recorded in the patient's medical record. Your internist instructs the patient about the condition and advises him to call again if his symptoms do not improve with the recommended treatment. No office visit is required. The call lasts nine minutes. You would report 99441.

Tip: Check with your individual payers to ascertain specific coverage for this service.

--Answers to You Be the Coder and Reader Questions were reviewed by Bruce Rappoport, MD, CPC, CHCC, a board-certified internist and medical director of Broward Health's Best Choice Plus and Total Claims Administration in Fort Lauderdale, Fla.