Ophthalmology and Optometry Coding Alert

Question: One of our regular patients has moved to a nursing home and is unable to come to the office now for treatment, but our doctor still needs to call in her prescriptions to the nursing home. Can I charge for these phone orders and, if so, how should I code so Medicare will pay?

California Subscriber


Answer: Medicare will not reimburse for telephone conversations, as specified in Section 15512 (B) of the Medicare Carriers Manual: "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)." You can bill only for face-to-face services on an outpatient, noncriticalcare basis.

Some insurance companies may provide reimbursement for telephone conversations. If you provide telephone services to a patient with private insurance, you should ask the payer for its policies and procedures for the telephone-call codes.


Answers to You Be the Coder and Reader Questions provided by Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.; and Shari Clark, COA, at Durrie Vision in Overland Park, Kansas.