Otolaryngology Coding Alert

Advantage: Telehealth services are classifiable by time.

When billing for patient consultations performed over the phone, keep in mind that Medicare will not reimburse your claim, nor will most commercial carriers. However, you might just get other payers to reimburse on a case to case basis, provided you stick to some specific guidelines.

Consider this scenario: An established patient with a history of colds leading to sinusitis calls his otolaryngologist to discuss new acute sinusitis symptoms. The nurse obtains a history via telephone, assesses the patient's condition, and talks to the ENT, who decides to prescribe an antibiotic. The nurse-to-patient call lasts 15 minutes.

Code it: You would report this with 98967 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion) based on time and personnel, rather than on complexity. However, if an appointment is scheduled to evaluate the patient before treatment is determined, you should not report this code.

Give Up Old TeleCare Codes

The 2008 Current Procedural Terminology (CPT®) replaced deleted codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...) with the existing codes for telephone call consultations: 99441 -- 99443 (Non-face-to-face physician telephone services). Times included in the new code descriptors will help you select the correct level of service, i.e.

• 99441 -- Telephone evaluation and management (E/M) service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; five to 10 minutes of medical discussion
• 99442 -- 11 to 20 minutes of medical discussion
• 99443 -- 21 to 30 minutes of medical discussion.

In addition, you can also bill for nonphysician telephone services: 98966 -- 98968 (Non-face-to-face nonphysician telephone services), which are for services by "qualified non-physician healthcare professionals."

Although reimbursement of these codes is a no-no for Medicare, some payers are actually agreeing to pay for it, said Penny Noyes, president and CEO of Health Business Navigators in Bowling Green, Ky., in an article How To Get Paid For Care Delivered Over The Phone on amednews.com (American Medical News) published on Feb. 1, 2010. In fact, CMS published relative value units (RVUs) that you can use as payment guide for non-Medicare plans.

Who Took The Call: Don't Forget To Document Your Conversation

If you find phone consultations becoming a real issue for your practice, you should consider billing these services, provided you adhere to these rules:

• Bill these codes only for the purpose of medical discussion not related to an E/M service that was provided within the last seven days and does not lead to an office visit within the next 24 hours or earliest possible date.
• Make sure the provider who took the call document the phone conversation. Document it like an in-person visit, with particular notation of the time spent, says the amednews.com article.
• Take note of the existing fee schedule for these codes and use them to determine what fee you will charge your patients for these codes. Although Medicare does not pay for these codes, you can expect to be paid the following figures:

  $8.49 for 99441and 98966 (0.41 nonfacility RVUs multiplied by the 2011 conversion rate of 33.9764)

  $16.99 for 99442 and 98967 (0.78 nonfacility RVUs multiplied by the 2011 conversion rate of 33.9764)

  $25.48 for 99443 and 98968 (1.15 nonfacility RVUs multiplied by the 2011 conversion rate of 33.9764).

• Don't forget that the patient must initiate the call in order for you to bill the service.
• Limit the coverage of these services for established patients only.

Bottom line: If you haven't started billing these telephone services, and would like to start doing it, it would be better to inform your patients ahead of time in order to clear the air and avoid confusion. Aside from telling your established patients that you would be charging for phone consultations, you should also specify what the charge is, and what the parameters are for the charges.