Orthopedic Coding Alert

Question: We have a new patient that called his physician to discuss his visit that took place three days prior to the call. How do I code for this?

Minnesota Subscriber 

Answer: Unfortunately, depending on the payer you are billing to, the call on its own may not be billable.

Very few payers, Medicare included, reimburse for telephone call codes 99441–99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian …) and 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian …).

But since the fee schedule includes relative values for 99441–99443 and 98966-98968, some private payers may pay for the codes. You need to remember that the guidelines are very specific for reporting these codes:

• The patient must be established to the practice. 
• The patient must have initiated the call to the physician.
• The information discussed on the call cannot be directly related to a visit seven or less days before the phone call.
• The call cannot take place within 24 hours of when the patient makes an appointment to see the physician regarding the health issue.

Alternative: If you can’t report 99441-99443 or 98966-98968, you may still be able to recoup some of the time your provider spent. Depending on the content of the call, the physician might be able to add the information into the history or decision making of the visit from three days ago. You might be able to use that information to count as the answers to questions about the dates of surgeries, prescriptions, or previous tests or perhaps relevant information the patient didn’t have at the time of the visit.