Pediatric Coding Alert

Question: A parent leaves a message seven days after the previous related E/M and wants phone care. Because the caller left the message on the office machine on a Sunday, we did not get the message until day eight. Can we bill for that phone call?

Also, can I use a phone care code for a call that a pediatrician makes to the emergency department (ED)?

Utah Subscriber

Answer: In scenario one, you can report the phone call eight days after the related E/M service with the 2008-introduced phone care codes (99441-99443, Telephone evaluation and management service provided by a physician to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment ...). Include related phone care that a pediatrician provides to a patient/ family member within seven days of the related E/M service.

Beware: Make sure you are not gaming the system by intentionally responding outside the time frame. As you indicate, you could not respond to the call within the seven days because you received the request when the office was closed.

Your second question hits on another phone care requirement. A 99441-99443 call must be from a physician to a patient/family member. A physician-to-physician call could count under care plan oversight if the patient is under a home health agency (99374-99375) or is receiving hospice care (99377-99378). No real option exists for a call from an office physician to an ED physician. Consider the time part of the related E/M service that the pediatrician may provide.

Catch this: The 2008 CPT introduced online medical evaluation (99444, Online evaluation and management service provided by a physician to an established patient, parent, guardian, or health care provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network) includes service provided by a physician to healthcare provider.