Pediatric Coding Alert

Question: Due to the large volume of non-emergent calls our pediatricians receive after 10 p.m., we are considering charging for after-hours calls. What CPT code should I use?


California Subscriber

Answer: You should use telephone call codes 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...). Check with your major insurers to see if the plans will reimburse the services.

Some Blue Cross/Blue Shield plans are paying for  after-hours calls. For instance, BCBS of California pays $18 for a level-two call (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 information and details, or to initiate new plan of care]).

Protect yourself: The pediatrician must document the call. Reserve 99371-99373 for calls of substance, not just quick calls (those calls that a nurse could handle).