Practice Management Alert

Question: A new patient came to our office, and the physician did a complete workup, resulting in a level-three new patient E/M visit. Later in the week the doctor called the patient to see how he was doing, to discuss questions the patient had, and to recommend a follow-up appointment. He spent 22 minutes on the phone with the patient and wants to bill for this time. Should we report a code for the telephone service? The doctor thinks since there are telephone codes, we should report them. I don't think this is a billable service. Who is correct?

Delaware Subscriber

Answer: You are correct. CPT offers three telephone service codes:

- 99441 -- Telephone evaluation and management service provided by a physician 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 -- - 11-20 minutes of medical discussion

- 99443 -- - 21-30 minutes of medical discussion.

Although reporting 99443 might seem like the right choice because the physician spent 22 minutes on the phone discussing the patient's care, the code descriptors for these codes specify that you cannot report 99441-99443 within seven days of an E/M service. Therefore, you cannot bill for this telephone call.

Pointer: You can consider the telephone conversation between a provider and patient as a factor when determining a service level for any follow-up related E/M service -- if your physician's documentation showed how the telephone conversation affected the key components of history, exam, and medical decision making for the future E/M service. You can fold the phone call time into the medical decision making (MDM) for the follow-up service and, depending on the documented nature of the presenting problem, level of history, or exam, this additional time may help you be able to code a higher-level E/M service.