Otolaryngology Coding Alert

Question: The mother of one of our child patients spoke on the phone to our physician about possible surgery on her child. Due to several factors they live three hours away, and the child has multiple handicaps, including an inability to communicate the parent did not want to bring the child in for an appointment if surgery will not be indicated. Can we charge an evaluation and management (E/M) service if there is no face-to-face contact with the patient?

Maine Subscriber

Answer: No, you may not charge an E/M service without face-to-face contact. Although CPT lists two telephone consult codes (99371, telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care 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] and 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]), these are rarely if ever paid by private carriers, and Medicare considers them noncovered services. The only way to obtain payment is to charge the patient for the service, says Melissa Pointer, CPC, a coder with the department of otolaryngology at the University of Arkansas in Little Rock.

Phone consultations with patients, and especially with other physicians if documented correctly can increase the level of medical decision-making of the patients next visit, however. In addition, time spent on the phone may be applied to the next visit, Pointer adds.

Note: Otolaryngologists in rural areas should check with their non-Medicare payers before assuming 99371 and 99372 arent covered. Private carriers may cover some phone consultations in rural areas because of the long distances involved and the difficulty the patient may have in seeing the physician.