Otolaryngology Coding Alert

If you choose to bill for allergist-made telephone calls, you now have solid backing for your position.

The American Academy of Pediatrics (AAP) recently released a statement advocating physicians charging and payers reimbursing for these services. Surveys show the increasing burden of telephone care. Consider these tips for rethinking your telephone policy.

You may have been reluctant to charge for telephone calls--just like form completion--for fear of alienating parents, causing them to leave your practice. -Yet, anecdotal reports suggest that many of these fees have become commonplace in offices across the country without patient exodus,- the AAP says in its -Policy Statement: Payment for Telephone Care.-

The AAP also argues against two reasons physicians give for not charging for this work:

1. You may have -ethical concerns that billing for telephone care may create a barrier to healthcare access and deter poor families from calling with serious problems,- the AAP says. But this same concern applied to and was unfounded when copayments were first introduced.

In fact, because the U.S. has a market-driven system, justifying giving this service for free is actually harder to support. The AAP instead recommends that citizens and policy-makers debate this issue.

2. Are you worried that charging for telephone calls will place a financial burden on the nation's healthcare system? Actually, telephone care can avoid higher-costing ED and office visits--reducing, rather than increasing, medical expenses, the AAP says.

Physicians cannot continue to bear the enormous cost of telephone care, says Joel Bradley Jr., MD, with Premier Medical Group in Clarksville, Tenn. -We must learn to recover our costs by using telephone-call codes,- he says.

You may shy away from using telephone-call codes 99371-99373 due to their lack of time allotments. Select the appropriate code based on the level of work, Bradley says. Think of the codes this way:

99371 Simple or brief                                       Report on tests, clarify instructions, adjust therapy

99372 Intermediate                                          Advice on a new problem, initiate therapy, discuss tests in detail

99373 Complex                                               Lengthy counseling session, detailed or prolonged discussions regarding serious illness

Thorough notation is key when reporting telephonecall services. -Documentation should fulfill the need for continuity of care, demonstrate the complexity of the call, and meet the requirements of the typical E/M visit,- the AAP states.

Bradley suggests including these documentation items:

- the time spent on the call

- a general note about the encounter's content including the key elements of history and medical decision-making.

Don't forget: To demonstrate the expertise required and the complexity of the decision-making process, the AAP suggests that -the physician document the type of telephone encounter.- Keep these examples in mind:

- new problem

- review of chronic problem with change in management

- interpretation of test results

- coordination of care.

Not all telephone calls are billable. -There is a certain amount of telephone care that is included in an E/M service's pre- and post-work,- says Richard H. Tuck, MD, FAAP, a national coding speaker and educator.

For instance, if a call results in an E/M service within 24 hours, you shouldn't bill for the telephone care, according to the AAP's policy statement.

Right way: If you decide to report telephone-care services that a physician provides to an established patient, the AAP approves billing for these kinds of encounters:

1. Physician manages a new problem, including counseling, medical management, and coordination of care not resulting in an office visit within 24 hours.

Example: After diagnosing Billy with asthma (such as 493.01, Extrinsic asthma; with status asthmaticus), an allergist calls the school nurse and physical education instructor about implementing his instructions. The physician could charge for his telephone time with 99373.

2. Physician manages an existing problem for which the patient was not seen in a face-to-face encounter in the previous seven days.

Example: Billy has an asthmatic attack at school (such as 493.02, ... with [acute] exacerbation) and the allergist pulls the patient's chart and calls the school nurse with revised instructions. Report code 99371. ❧