Practice Management Alert

If your physician is on the cutting edge of the technology boom, you face the daunting task of trying to bill for the electronic services he provides. Good news: Starting Jan. 1, your coding life may get easier with new telephone service and e-visit codes.

Three new codes for 2008 will allow you to report the telephone E/M services your physician performs based on the phone call length.

Old way: The current telephone service 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 ...) -- depend on the call's complexity level. You-re forced to decide if the call is simple, intermediate or complex in order to be able to choose a proper code. With the new codes, you can eliminate that decision.

CPT 2008 will delete 99371-99373 and replace them with three new time-based codes:

"While these codes are primarily reported based on the time spent communicating with the patient, proximity of in-office services will also determine whether the call can be charged," says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies in Powder Springs, Ga.

Note: The telephone call is a non-face-to-face E/M service. For you to code for it, the patient must already be established with your office. Also, you cannot report a telephone service code if the physician call takes place within seven days of a recent previous visit, a surgical or diagnostic procedure, or a scheduled upcoming E/M service. CPT considers these part of a previous or upcoming visit and billable as part of the subsequent E/M code chosen.

"I think that time-based reporting versus trying to determine what is -simple,- -intermediate- or -complex- is definitely a good thing," says Denae M. Merrill, CPC, physician coder for Covenant HIM in Saginaw, Mich. "You then have a clear-cut definition of what is what. A provider will then know what is important to document, and a coder will know what code is most appropriate, and there will be no room for arguing."

How it works: The new time-based telephone call codes will not only have a seven-day pre-global period, but can also not result in an office visit. CPT's introductory paragraph to the new phone service codes will instruct you to avoid these codes if your physician sees the patient for an E/M visit "within 24 hours or next available urgent visit appointment."

Move to Category I: Right now you have a Category III code, added in 2005, to recognize e-visit services -- 0074T (Online E/M service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient's request, established patient). Because physicians and payers don't consider this service type "emerging technology" anymore, CPT 2008 deletes 0074T, replacing it with a Category I e-visit code for you to start reporting in January: 99444 (Online E/M service provided by a physician to an established patient, guardian, or healthcare provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network). This is an example of a Category III code becoming a Category I code because of use, experts say.

"This code has similar requirements regarding the proximity of the telephone call to any in-office services," Parman says.

Warning: Just because you have new codes doesn't mean Medicare or other carriers will pay. "New codes, or codes that are transitioned from Category III to Category I, do not mean more reimbursement," Merrill says. "It often takes the payer community time to get on the bandwagon and start reimbursing. Even then, you may find they will create guidelines to limit reimbursement to specified criteria only."

You-ll have to wait until the 2008 Medicare Physician Fee Schedule comes out to see if CMS assigns 99444 relative value units (RVUs) and a fee. "There are a number of codes that are present in the CPT or HCPCS manual that do not have any reimbursement attached to them," Parman says.

Remember: As with telephone service codes 99441-99443, you should apply 99444 only if the e-visit is unrelated to any previous service within the past week. "It appears that both the telephone services and online services would be reported only if they took the place of a visit," Parman says. Also, you will want to be sure that the physician develops separate documentation to show that the e-visit is significant and independent of other recently provided services.

Keep checking: Watch for more on the latest CPT code changes in the next issue of Medical Office Billing & Collections Alert.