Ophthalmology and Optometry Coding Alert

Question: I noticed that CPT has codes for telephone calls. Should I be using them to report calls my doctor makes to patients?


North Dakota Subscriber

Answer: Although CPT does include codes for telephone calls, only an occasional carrier will pay for the calls. The codes are:

• 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

• 99372--... intermediate
• 99373--... complex or lengthy.

Medicare, however, has never reimbursed for telephone calls. Occasionally, some private carriers will pay on these codes, so you can try reporting them and see if the carrier pays you.

Note: Remember that if you do receive payment, many times the carrier also requires a co-payment from the patient. So, although you may receive payment from the carrier, the carrier may also require a $10 or $15 co-pay from the patient. Many patients are not too happy about or receptive of this charge, especially if the physician doesn't inform them of a possible co-pay before the telephone call takes place.

Most insurance carriers consider these types of telephone calls part of your doctor's business tasks, and therefore will not reimburse anything for them. Payers also will not pay on nurses' calls to patients.

Pointer: You can, however, use the information your doctor obtains from a telephone call at a later face-to-face patient visit in the office.

If, after the telephone calls, the ophthalmologist sees the patient for the first time in the office, you should report a new patient visit even if the physician has treated the patient over the phone.

Without a previous face-to-face visit, for coding purposes the patient is a new patient on any subsequent encounter.