Practice Management Alert

Question: Occasionally our practice will provide patients with counseling, coordination of care services, or discussion of test results over the phone. Our physician usually does this for very serious or complex cases. Our nurses and nurse practitioners do this more frequently to provide simple services, such as helping diabetic patients manage their daily blood glucose levels. Would it be appropriate to bill for any of these services using 99371-99373? Do these codes usually get reimbursed?

Oregon Subscriber Answer: While CPT does provide codes for phone services, the majority of payers, including Medicare and Medicaid, do not reimburse for these codes. Generally payers feel that phone services are part of the "cost of doing business" and are covered in the practice expense RVU when they reimburse for office or other outpatient services.

Payers reimburse for face-to-face professional services, but you should ask your payers if they will cover a phone service instead. For example: You tell a payer you could start asking your diabetes patients to come in for a nurse's help with blood glucose level management and be able to charge 99211 for the visit, but instead you offer to continue phone services if they will be paid. Some payers may feel the phone services are worth paying since it will be less expensive than reimbursing for the office visits.