Neurology & Pain Management Coding Alert

Question: Our neurologist receives nonemergent calls after 10 p.m. We are considering charging for after-hours calls. What CPT code should I use?


California Subscriber


Answer: Although telephone codes are available in CPT, they do not have published relative values and are poorly recognized by some payers, depending on the state you reside in.

First, the bad news: The Medicare Physician Fee Schedule applies the -B- status for telephone call codes, meaning that these are bundled services. Medicare considers payments for these calls included in the reimbursement for E/M services.

If you are charging for telephone calls, you should use telephone call codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...). Ask your major insurers if the plans will reimburse the services.

Some Blue Cross/Blue Shield plans are paying for after-hours calls. For instance, BCBS of California pays $18 for a level-two call (99372, ... intermediate [e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone, to discuss test results in detail, to coordinate medical management of a new problem in an established patient, to discuss and evaluate new information and details, or to initiate new plan of care]).

Protect yourself: The neurologist must document the call. Reserve 99371-99373 for calls of substance, not just quick calls (those calls that a nurse could handle). Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.