Pediatric Coding Alert

Great news: The AAP supports payers reimbursing for 3 types of telephone care
 
If you choose to bill for telephone calls, you now have solid backing for your position.

The American Academy of Pediatrics (AAP) recently released a statement advocating physicians charging and payers reimbursing for these services. Surveys show the increasing burden of telephone care. Consider these tips for rethinking your telephone policy.

Tip 1: Consider Charging Acceptable

You may have been reluctant to charge for telephone calls -- just like form completion -- for fear of alienating parents, causing them to leave your practice. "Yet, anecdotal reports suggest that many of these fees have become commonplace in offices across the country without patient exodus," the AAP says in its "Policy Statement: Payment for Telephone Care" published in Pediatrics October 2006.

The AAP also argues against two reasons pediatricians give for not charging for this work:

1. You may have "ethical concerns that billing for telephone care may create a barrier to healthcare access and deter poor families from calling with serious problems," the AAP says. But this same concern applied to and was unfounded when copayments were first introduced.

In fact, because the U.S. has a market-driven system, justifying giving this service for free is actually harder to support. The AAP instead recommends that citizens and olicy-makers debate this issue.

2. Are you worried that charging for telephone calls will place a financial burden on the nation's healthcare system? In actuality, telephone care can avoid higher costing ED and office visits -- reducing rather than increasing medical expenses, the AAP says.

Tip 2: Learn Code Categories

Pediatricians cannot continue to bear the enormous cost of telephone care, says Joel Bradley Jr., MD, pediatrician at Premier Medical Group in Clarksville, Tenn. "We must learn to recover our costs by using telephone-call codes," he says.

You may shy away from using telephone-call codes 99371-99373 due to their lack of time allotments. Select the appropriate code based on the level of work, Bradley says.  Think of the codes this way:

Code                 Level of work                       Examples
99371              Simple or brief                      Report on tests, clarify instructions, adjust therapy
99372              Intermediate                          Advice on a new problem, initiate therapy, discuss tests in details
99373              Complex                                 Lengthy counseling session, detailed or prolonged discussions regarding serious illness

Tip 3: Use CPO for Frequent Patient Mgt

For patients who require chronic care or disease management, consider reporting telephone care as care plan oversight services. CPO codes 99374-99375 and 99377-99380 "are cumulative over a 30-day period and are reported according to total physician time spent with these activities," according to the telephone-care policy.

Important: Although you should include telephone time in these CPO codes, the services these codes describe are much broader.

Consider using a CPO form for patients who require monthly services. Staple the sheet on the outside of the patient's chart. That way, the pediatrician can easily record any time she spends on qualifying services.

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Do this: Each documentation encounter entry must include:

• the complexity (telephone codes)

• or time (care plan oversight).

Tip 4: Document These Phone Details

Thorough notation is also key when reporting telephone-call services. "Documentation should fulfill the need for continuity of care, demonstrate the complexity of the call, and meet the requirements of the typical E/M visit," the AAP states.

Bradley suggests including these documentation items:

• the time spent on the call

• a general note about the encounter's content including the key elements of history and medical decision-making.

Don't forget: To demonstrate the expertise required and the complexity of the decision-making process, the AAP suggests "the physician document the type of telephone encounter." Keep these examples in mind:

• new problem

• review of chronic problem with change in management

• interpretation of test results

• coordination of care.

Tip 5: Charge for 3 Types of Calls

Not all telephone calls are billable. "There is a certain amount of telephone care that is included in an E/M service's pre- and post-work," says Richard H. Tuck, MD, FAAP, a national pediatric coding speaker and educator.

For instance, if a call results in an E/M service within 24 hours, you shouldn't bill for the telephone care, according to the AAP's policy statement.

Right way: If you decide to report telephone-care services that a physician provides to an established patient, the AAP approves billing for these kinds of encounters:

1. physician manages a new problem, including counseling, medical management, and coordination of care not resulting in an office visit within 24 hours.

Example: "After diagnosing Billy with ADD, a pediatrician calls the school nurse and the school psychologist about implementing his instructions," Tuck says. The physician could charge for his telephone time with 99373.

2. physician manages an existing problem for which the patient was not seen in a face-to-face encounter in the previous seven days.

Example: Billy has an out-of-control temper tantrum at school and the pediatrician pulls his chart and calls the school nurse with revised instructions, Tuck says.

3. care plan oversight for patients with special needs in residential settings and/or those with a chronic disease who require physician supervision over a period of time during a calendar month.