Pediatric Coding Alert

Question: A pediatrician talked to a mom who called in because her toddler's gum was stuck between her front teeth after a fall. We initially charged a telephone care code because the mother was able to stop the bleeding. But the child kept crying, so the mother brought her in that afternoon, and we billed an office visit. Can I still report the call code?

Florida Subscriber

Answer: No, "if the telephone service ends with a decision to see the patient within 24 hours or the next available urgent visit appointment," you should not report the telephone service code, according to "Coding Communication: Non-Face-to-Face Physician Services: Telephone Services" in CPT Assistant March 2008. You would instead code only the office visit (99212-99215, Office or other outpatient visit ...).

Although the recently released AMA article delineates the same rules outlined in CPT 2008 for telephone care codes (99441-99443), you may want to reference the article during insurer coverage negotiations. The article further states: "Telephone services expand healthcare access for patients who may not need or are unable to come to a physician's office. These services can also make available advice and care to those who might otherwise seek more expensive care in an urgent care center or overcrowded emergency department, and offer a solution in helping to decrease healthcare costs by providing an alternative to more costly face-to-face services."

-- Answers to You Be the Coder and Reader Questions provided/reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.; Donelle Holle, RN, a pediatric coding and auditing consultant; Richard Lander, MD, FAAP, Essex-Morris Pediatric Group in Livingston, N.J.; Peter Rappo, MD, FAAP, a pediatrician and clinical professor of pediatrics at Harvard Medical School in Boston; Richard H. Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville