Orthopedic Coding Alert

Question: A patient presented 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 coded with 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.) 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 (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 not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion) through 99443 (… 21-30 minutes of medical discussion), 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.