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 [...]