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Pediatric Coding Alert

Reader Question:

Avoid 'Phone' Codes for Visit Follow-Ups

Published on Tue May 08, 2012

Question: Our pediatrician saw two patients on Friday who subsequently had increased bilirubin levels over the weekend. On Saturday, the physician ordered phototherapy, and discussed the lab results with the parents over the phone. The patients followed up in the office on Monday. How can we bill for the phone management on the weekend?Minnesota SubscriberAnswer: According to CPT rules, you cannot report the telephone management codes (98966-98968) if the patient was seen by the physician for a related E/M service within the previous seven days or if the phone call leads to an E/M service or procedure within the next 24 hours or the next available urgent visit appointment. It sounds like your patients were seen both before and after the phone call, which precludes you from reporting one of these codes.However, you might consider reporting code 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) [...]
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