Medicare Compliance & Reimbursement

CPT puts time on coder's side in 2008

If figuring the level of service for telephone E/Ms has made you reticent to file the codes, CPT 2008 has some great news.

The latest version of CPT deletes 99371-99373 (Telephone call by a physician to patient or for consultation or management of for coordinating medical management with other health care professionals ...) and offers you a much simpler method for coding, as well as some specific nonphysician counseling codes.

Phone E/M Codes A Boon--If Payors Accept Them

CPT will roll out three new codes for telephone E/M care in 2008, reported Joel Bradley Jr., MD, FAAP, a member of the AMA CPT Editorial Panel at The Coding Institute's 2007 Pediatric Coding & Reimbursement Conference. "The length of the call will determine which code to pick," he explained.

Deleted: CPT codes 99371-99373.

Added: The following CPT 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. Benefit: Codes 99371-99373 required you to decide if the call is simple/brief, intermediate or complex. Now, all you'll have to do is find total encounter time.

You may also have more guidance on which phone calls you should include as part of an E/M service and which you should report separately.

The telephone care codes "will have a global period of seven days," Bradley says. "If you treat the problem in the office within seven days before or after the phone call, you would not bill" the telephone care.

This is good news for coders--provided insurers jump on board with the new code.

The time-based phone codes "may help, if the payors reimburse these codes. However, just because there are codes does not mean a payor will pay," explains Quinten Buechner, president of ProActive Consultants in Cumberland, WI. "Insurers may bundle [the service] or just refuse to pay; Medicare will want evidence of face-to-face [service] unless it specifically adopts these codes for payment," he says.

Bradley agrees, saying "CMS will need to publish RVUs [relative value units]" for possible payment of the new codes to move forward.

Best bet: Proceed carefully when using 99141-99143; check with your payor before filing with any of them.

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