Oncology & Hematology Coding Alert

Question: We had a patient present to the office for a follow-up appointment. When the patient arrived, they were coughing, and we found out they had active COVID. We placed the patient in a room, and the provider conducted the visit over the phone. Both the provider and the patient were in the same office, but the provider did not physically see the patient. The entire visit with the provider was over the phone with no video — just audio. Would this be billed as a phone visit (99441-99443) or an office visit (99212- 99215)?

AAPC Forum Participant

Answer: Office and outpatient evaluation and management (E/M) visits 99202-99215 (Office or other outpatient visit for the evaluation and management of a/an new/established patient …) require a face-to-face encounter. They may also be reported as a synchronous (real-time) interactive audio-video telemedicine service by appending modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) if there is both an audio and video component to the encounter.

As the encounter you describe was audio only, and there was no video or face-to-face component to the visit, you will not be able to bill the encounter this way despite the fact the encounter occurred within your office. Instead, you should use a code from 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional …) providing all the other criteria for these telephone E/M codes have been met. But before you do, make sure you contact your payer to see if there are any special instructions for this unique E/M scenario.