Otolaryngology Coding Alert

Use time, service type and care complexity to recoup pay

If you're not reporting phone calls because of coding and compliance concerns or reimbursement issues, you could be losing as much as $50 a day.

To stop you from giving telephone calls away as a gift, experts tackle your most significant problems regarding coding for this service.

1. Difficulty Determining the Complexity Level

Even though the telephone call codes aren't time-based, you can easily distinguish between the three call types by the code descriptions, says Julia M. Pillsbury, DO, FACOP, FAAP, a physician practicing in Dover, Del.:

Simple: 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 (e.g., to report on tests and/or laboratory results, to clarify or alter previous instructions, to integrate new information from other health professionals into the medical treatment plan, or to adjust therapy)

Intermediate: 99372, ... intermediate (e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone, to discuss test results in detail, to coordinate medical management of a new problem in an established patient, to discuss and evaluate new information and details, or to initiate new plan of care)

Complex: 99373, ... complex or lengthy (e.g., lengthy counseling session with anxious or distraught patient, detailed or prolonged discussion with family members regarding seriously ill patient, lengthy communication necessary to coordinate complex services of several different health professionals working on different aspects of the total patient care plan). 
 
Just remember to report the following telephone code in these instances:
 

99371. Use the simple or brief code when you call a parent to:
   report test results
   clarify or alter prior instructions
   integrate new information
  adjust therapy.
 

99372. Report the intermediate telephone call code when you:
   advise or coordinate established patient care with healthcare professionals
   initiate therapy that can be handled by phone.
 

99373. Assign the complex or lengthy code for:
  complex or lengthy counseling or care coordination
  prolonged discussion.

2. Coding Calls Could Raise a Red Flag

As long as you properly document telephone care, you shouldn't worry about not coding a service merely because a payer could scrutinize it -  the HHS Office of Inspector General (OIG) is targeting modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) claims, but that shouldn't stop you from reporting telephone services.

The problem is, however, that CPT offers no guidance regarding documentation for reporting telephone calls, Pillsbury says. Therefore, she recommends when billing for a call to document:
 

time spent

type of service provided      

consultation or medical management       

initiate or adjust therapy       

report results       

coordinate patient care with other healthcare professionals      

new or existing problem 

complexity of care         

how many providers you contacted        

risk        

medical decision-making.

Best documentation practices: For instance, when a parent calls in to speak to the allergist about a child's asthma treatment, you can pull the patient's chart and leave the note on the physician's bulletin board with the chart in a bin below the board. Then at lunch, the allergist can call the parent and document the call, coding experts say. 

Note prototype: You're documenting phone calls properly if you follow this example: Discussed how asthma medicine is working - mom doesn't think drug XYZ is doing the job. Teacher agrees. Need to increase the dose (or need to change to medicine ABC). Mom to call me in two to three weeks with how new medicine/dose is working (18 minutes).

3. Reimbursement Isn't Worth the Trouble

If you're worried that coverage for telephone calls doesn't justify the cost and time that you spend coding for these services, consider some statistics:

Insurers pay for about 30 percent of billed phone charges.
  

Medicaid programs in some states, such as Kentucky, Nebraska, New Hampshire, Virginia and Washington, cover 99371-99373.
  

A 2001 Medicaid fee survey indicates average payments of $6.64 for 99371, $14.32 for 99372, and $20.82 for 99373.

At one practice, staff recently started billing for actual services that the physician provides, such as calling in a prescription, which saves the patient a trip to the doctor, says Annette Goldwyn, CPC, compliance officer at the 11-provider, three-location practice in Fort Myers, Fla. Coding for these services could really add up. Although only reporting 99371-99373 for appropriately documented calls, she estimates the practice will increase its overall "charges" by roughly $13,000 annually.

And if an insurer doesn't cover 99371-99373, you can sometimes bill the patient, experts say. Before charging the patient for the telephone call, make sure the payer contract allows you to do so. Watch out for explanation of benefits that denies 99371-99373 as "inclusive." That means the insurer includes telephone calls in the E/M service. In this case, you shouldn't bill the patient. But if the payer denies the telephone care as a noncovered service, you may charge for the service.