Pediatric Coding Alert

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 tell the differences among the three calls, says Julia M. Pillsbury, DO, FACOP, FAAP, a pediatrician at the Center for Pediatric Medicine 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:
 
Code 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.
 
Code 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.
 
Code 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 Office of Inspector General  is targeting modifier -25 claims, but that shouldn't stop you from reporting telephone services.
 
The problem is, however, that CPT offers no guidance on 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: To facilitate proper note-taking at Medford Pediatric & Adolescent Medicine PA in Medford, N.J., staff pull the patient's chart when a parent wants to speak to a pediatrician directly, says Charles A. Scott, MD, FAAP, a pediatrician at the office. The assistant leaves the note on the physician's bulletin board with the chart in a bin below the board. Then at lunch, the pediatrician can call the parent and be prepared to document the call, he says.
 
Note prototype: You're documenting phone calls properly if you follow this example: Discussed how medicine is working - mom doesn't think stimulant XYZ is doing the job. Teacher agrees. Need to increase the dose (or need to change to medicine ABC). Mom to call me in 2-3 weeks with how new medicine/dose is working (18 min).

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 indicated average payments of $6.64 for 99371, $14.32 for 99372, and $20.82 for 99373.
  An American Academy of Pediatrics report found that pediatricians charged the following median prices for 1999 telephone calls: $19.00 for 99371, $36.00 for 99372, and $54.50 for 99373.
 
At Island Coast Pediatrics, staff recently started billing for actual services that a pediatrician 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. While 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, Scott says. Before charging the patient for the telephone call, make sure the contract allows you to do so, he says. Watch out for evaluation of benefits that deny 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, he says.