Billing Options to Get Payment For Telephone Calls
Published on Sat Jul 01, 2000
Although most ob/gyns spend considerable time on the phone with patients and CPT has codes for this service, the fact is that telephone calls do not get reimbursed. Is there any recourse to this rejection by the insurance industry?
CPT codes for telephone calls include:
99371 (telephone call by a physician to patient or for consultation or medical management for coordinating medical management with other health care professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists]; simple or brief [e.g., to report on tests and/or laboratory results, to clarify or alter previous instructions, to integrate new information from other health professionals into the medical treatment plan, or to adjust therapy]).
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 or details, or to initiate new plan of care])
99373 ( ... complex or lengthy [e.g., lengthy counseling session with anxious or distraught patient, detailed or prolonged discussion with family members regarding seriously ill patient, lengthy communication necessary to coordinate complex services of several different health professionals working on different aspects of the total patient care plan])
A Common Practice
Few ob/gyns would look at the above codes and not be able to think of countless times that they have provided this type of service to a patient. So why do Medicare and virtually all commercial insurers reject these codes when submitted for reimbursement? Medicares guidelines for the codes, as excerpted from the Medicare Carriers Manual, spell out the policy succinctly:
Telephone Calls Do not pay for telephone calls (codes 99371-99373) because payment for telephone calls is included in payment for billable services (e.g., visit, surgery, diagnostic procedure results).
Commercial carriers also take the position that telephone calls are included in the evaluation and management (E/M) visit or global care period, and simply are not something for which they should have to reimburse a physician. Yet providing telephone support to patients is an essential part of every ob/gyn practice. Often, patients need extra counseling even reassurance from their physician when discussing test results or treatment plans. Geographic challenges, scheduling conflicts, or even apathy on the patients part can make telephone contact a needed alternative to the face-to-face office visit.
Seetha S. Aiyar, MBA, administrator to the Cleveland Clinic Foundation department of gynecology & obstetrics, a 27-physician/midwife staff practice in Cleveland, sees no ambiguity in the need for patients to have phone access to their physicians and vice-versa. In many cases, says Aiyar, the ob/gyn is the only [...]
