Neurology & Pain Management Coding Alert

Add phone time onto next E/M service -- and possibly get paid

Almost every physician has to call another physician or medical professional to discuss a patient. Your challenge is finding out how to collect for the time your neurologist spends on the phone. Can you actually get paid for his phone time?

The answer is yes -- if you pay attention to details and follow your carriers- guidelines.

Know the Codes, But Don't Make Assumptions

CPT does include three codes for telephone services, but don't expect to always get paid when you submit those codes:

- 99371 -- 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); simple or brief

- 99372 -- - intermediate

- 99373 -- - complex or lengthy.

Most insurance payers consider these types of telephone calls part of your physician's business tasks, and therefore will not reimburse anything for them. Medicare has never paid on these codes, and there are no published relative value units for 99371-99373.

-This is due to there being no direct -face-to-face- contact between the physician and the patient,- says Kimberle R. Greuel, RHIT, CPC, reimbursement analyst lead for MeritCare Health System in Fargo, N.D. -The physician has already developed a relationship with the patients and will from time to time need to discuss issues with them by telephone, whether it is giving them lab results, answering questions on medications, etc. It is understood from the payer perspective this is part of good patient care.-

Check With Individual Payers

Don't give up hope, however, of getting paid for some of your neurologist's patient-related phone calls.

Occasionally, some private payers will pay for 99371-99373, so you can try reporting them and see if the carrier pays you.

Example: 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).

Caution: Consider the public-relations aspect of a denied claim before you submit telephone charges to a carrier.

-If you bill the service to an insurer that doesn't cover the service, the bill could drop to the patient, which is a PR nightmare,- says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania's department of medicine in Philadelphia.

Next step: If the payer doesn't pay the claim, experts recommend that you write it off to a special category of -phone calls not paid,- and don't bill it to the patient. Keep track of the write-off information and use that information to negotiate with your payer later on. Having this negotiating strategy in mind is especially helpful for rural communities in which patients don't necessarily come into the office.

Count Calls Toward MDM When Possible

Just because your payer doesn't recognize 99371-99373 doesn't mean that your physician's time isn't reimbursable. The most widely recommended option for getting reimbursed under these circumstances 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.

Although phone time won't increase the level of E/M service, phone calls -- especially consultations with other physicians -- can help boost your neurologist's level of medical decision-making (MDM) for the patient's next visit.

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

-Telephone calls are inclusive in the payment for the E/M pre- or post-service work,- Pohlig says. -If it's documented appropriately, you can receive credit in the amount and complexity of data in medical decision-making.-

Beware: Time Shouldn't Affect Service Level

Phone call time that you bundle into the E/M visit should not usually affect your physician's level of service. Look for specific signs that a phone call was significant and should count toward the next E/M visit. These signs include:

- the decision for more treatment after the phone call or a prescription (or even a refill) or a dosage change over the phone

- 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 complexity of medical decision-making at the patient's next visit when wrapped into the context of that visit's MDM.