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Oncology & Hematology Coding Alert

Avoid These Phone-Reporting Myths - and Save $50 a Visit

Published on Mon May 10, 2004

Use time, service type and care complexity to recoup pay

Is your oncology practice not reporting phone calls because of coding and compliance concerns or reimbursement issues? Then you could be costing your practice as much as $50 a day.

If you want to stop giving telephone calls away as a gift, follow this expert advice for tackling your most significant problems regarding coding for this service.

1. Difficulty Determining the Complexity Level

Even though the telephone-call codes aren't time-based, you can easily distinguish between the three call types by the code descriptions, says Julia M. Pillsbury, DO, FACOP, FAAP, a physician practicing in Dover, Del.:

  •  Simple: 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 (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)

  •  Intermediate: 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)

  •  Complex: 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).

    Just remember to report the following telephone code in these instances:

    99371. Use the simple or brief code when you call a parent to:

  •  report test results
  •  clarify or alter prior instructions
  •  integrate new information
  •  adjust therapy.
     
    99372. Report the intermediate telephone-call code when you:
  •  advise or coordinate established patient care with healthcare professionals
  •  initiate therapy that can be handled by phone.
     
    99373. Assign the complex or lengthy code for:
  •  complex or lengthy counseling or care coordination
  •  prolonged discussion.

    2. Coding Calls Could Raise a Red Flag

    As long as you properly document telephone care, you shouldn't worry about not coding a service merely because a payer could scrutinize it.

    The HHS Office of Inspector General is targeting modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) claims, but that shouldn't stop you from reporting telephone services.

    The problem is, however, that CPT offers no guidance regarding documentation for reporting telephone calls, Pillsbury says. Therefore, she recommends when billing for a call to document:

  •  time spent
  •  type of service provided
  •  consultation or medical management
  •  initiation or adjustment of therapy
  •  report results
  •  coordination of patient care with other healthcare professionals
  •  new or existing problem
  •  complexity of care
  •  how many providers you contacted
  •  risk
  •  medical decision-making.

    Best documentation practices: Some oncologists use a telephone documentation form to record phone calls. This form allows the receptionist or other office staff to document the caller's name, whether the caller was a patient or relative, the time of the call, and the specific
    problem. Once the receptionist provides the form and the patient's chart to the physician, he can return the call and address the patient's problem.

    Your oncologist should document in the medical record any instructions or advice he gave during a phone conversation along with the patient's condition. Your physician should include this information even if your carrier won't pay separately for the calls. The doctor may include documented calls in the E/M level's review of data, history component, or medical decision-making.

    Note prototype: Be sure the oncologist indicates the claim as a telephone consultation, using the appropriate E/M code (99371, 99372 or 99373). Also, note the phone call's date and time, along with the physician's diagnosis or signs and symptoms, and the physician's advice and instructions. The oncologist should sign the record and date the signature.

    3. Reimbursement Isn't Worth the Trouble

    If you're worried that coverage for telephone calls doesn't justify the cost and time that you spend coding for these services, consider some statistics:

  •  Insurers pay for about 30 percent of billed phone charges.
  •  Medicaid programs in some states, such as Kentucky, Nebraska, New Hampshire, Virginia and Washington, cover 99371-99373.
  •  A recent Medicaid fee survey indicates average payments of $6.64 for 99371, $14.32 for 99372, and $20.82 for 99373.

    At one practice, staff recently started billing for actual services that the physician provides, such as calling in a prescription, which saves the patient a trip to the doctor, says Annette Goldwyn, CPC, compliance officer at the 11-provider, three-location practice in Fort Myers, Fla. Coding for these services could really add up.

    Although only reporting 99371-99373 for appropriately documented calls, she estimates the practice will increase its overall "charges" by roughly $13,000 annually.

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