Practice Management Alert

Question: I work for a surgery practice, and we offer phone consultations for new patients, but potential patients tend to have a lot of questions before they ever make it into the office. Can we bill evaluation and management (E/M) codes like 99441-99443 or 99421-99423 to reimburse the providers for their time?>

Texas Subscriber>

Answer: According to Codify by AAPC, all of the codes you mention are appropriate only for established patients:

• 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes)
• 99422 (Online digital evaluation and management service, for an established patient … 11-20 minutes)
• 99423 (Online digital evaluation and management service, for an established patient … 21 or more minutes …)
• 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided 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; 5-10 minutes of medical discussion …)
• 99442 (Telephone evaluation and management service by a physician … 11-20 minutes of medical discussion …)
• 99443 (Telephone evaluation and management service by a physician … established patient … 21-30 minutes of medical discussion …)
• Therefore, it wouldn’t be appropriate to bill potential patients (or their respective payers) for phone consul­tations with these codes.