Neurology & Pain Management Coding Alert

Question: Our physician spent 20 minutes during office hours on the phone providing advice and reassurance to an established patient who was having problems with medication. Can we be reimbursed for this time?

Virginia Subscriber

Answer: CPT includes three codes to report physician-to-patient telephone calls: 99371 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists]; simple or brief), 99372 ( intermediate) and 99373 ( complex or lengthy). These codes apply only if the physician contacts the patient, and you may not charge for incoming calls. Proper coding conventions suggest that you should track and report all services provided, but be aware that the CMS Physician Fee Schedule assigns no relative value units for 99371-99373, and Medicare will not reimburse for these services.

However, you may consider time spent on the phone when deciding on an E/M level for a subsequent visit, as long as you properly document the conversation. For instance, if a patient with medication difficulties calls asking advice and, after 10 minutes of questioning the patient, the physician determines that an immediate office visit is warranted, the content of the telephone conversation may become part of the E/M evaluation.

Some third-party payers may pay for telephone consults, or you may negotiate with your third-party payers to reimburse for these services as part of your contract. For an effective bargaining tool, provide a cost/benefit analysis that will prove to the insurer that allowing reimbursement for telephone consults will result in fewer office visits, thereby saving them money.

If reimbursement is not otherwise forthcoming, you may ask that the patient pay for telephone consults, although generally physicians prefer not to do so. In the case of a patient who expects to get the majority of his or her medical care over the phone, however, charging the patient may be the only way to ensure fair reimbursement for the physician's time.