Oncology & Hematology Coding Alert

Key: If phone call leads to office visit, you can't report both

In 2008, CPT will finally catch up with oncologists and hematologists using technology to answer their patients- questions.

The -e-visit- will migrate from the temporary Category III CPT codes to a permanent Category I code. Code 99444 (Online evaluation and management service provided by a physician to an established patient, guardian, or healthcare provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network) will replace 0074T in CPT 2008.

Although the Physician Fee Schedule reimbursement for 99444 has not been set, some insurers have already been paying as much as $25 for each 0074T claim, if the service meets certain criteria. For instance, BCBS of Tennessee requires the following criteria for 0074T payment:

1. Physician responds to the patient's request within 24 hours (except over the weekend, in which case he responds by end-of-day Monday).

2. And one or more of the following:

- Patient describes new symptoms and requests intervention and/or advice from physician to treat new symptoms

- Patient describes ongoing symptoms from a recent acute problem or chronic health problem and requests intervention and/or advice from physician to treat said problem

- Evidence that physician gives substantive medical advice, revises treatment plan, prescribes/revises medication, recommends additional testing, and/or provides self-care/patient education information for a new and/or chronic health problem

- Evidence that physician makes a new diagnosis and prescribes new treatment

- Patient requests interpretation of lab and/or test results with evidence that physician provides substantive explanation and possibly makes recommendations to modify treatment plan, revises medications, etc.

- Evidence that physician provides extended personal patient counseling that changes the course of treatment and impacts the potential health outcome.

There are also new codes for online E/M by a nonphysician (98969) and nonphysician telephone calls (98966-98968), says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

Best bet: Each insurer maintains its own coverage guidelines. Check with your payers for their own criteria for 0074T--or, in 2008, 99444--coverage.

Don't miss: Other new E/M codes in 2008 address somewhat older technology. Report -telephone evaluation and management services- provided to established patients with new codes 99441 (5-10 minutes of medical discussion), 99442 (11-20 minutes), or 99443 (21-30 minutes).

However: The new time-based telephone call codes will not only have a seven-day pre-global period but can also not result in an office visit, says national coding speaker Richard H. Tuck, MD, FAAP.

If you provide phone counseling and then see the patient within 24 hours or the next available visit, you forfeit the call code and should only report the E/M code for the office visit.

The introduction to codes 99441-99443 in the 2008 CPT manual will provide more detailed instructions and limitations, experts say.