Primary Care Coding Alert

Has the imprecise matching of simple, intermediate or complex to 99371-99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals ...) made you shy away from using these codes? CPT 2008 will offer you a much simpler method, as well as some specific nonphysician counseling codes.

If the AMA CPT panel gives final approval, you can look forward to implementing these CPT changes for Jan. 1. The following is based on general information available. Code specifics could vary on publication.

Three new codes for telephone E/M care have been proposed for 2008, said Joel Bradley Jr., MD, FAAP, a member of the AMA CPT Editorial Panel at The Coding Institute's 2007 Pediatric Coding & Reimbursement Conference. "The length of the call will determine which code to pick," he says.

Benefit: Codes 99371-99373 require you to decide if the call is simple/brief, intermediate or complex.

You may also have more guidance on which phone calls you should include as part of an E/M service and which you should separately report. The proposed telephone care codes "will have a global period of seven days," Bradley says. "If you treat the problem in the office within seven days before or after the phone call, you would not bill" the telephone care.

Example: A mother calls to report that a sibling has developed the same problem as the other child you recently treated. If the physician talks to the mother, in 2008 you could use a telephone care code based on time, rather than on complexity.

The big question for practices, however, will remain: Will payment make reporting the new telephone care codes worthwhile? CMS will need to publish RVUs (relative value units) for possible payment of the new codes to move forward, Bradley says.

You might fret over the difficulty of getting paid for the numerous nonphysician counseling services your practice could provide. But one of those services will no longer masquerade under the generic counseling and/or risk factor reduction intervention codes (99401-99412, for patients with no symptoms or established illness) or health and behavior assessment/intervention codes (96150-96155, for patients with disease-related problems).

Look for two Medicare-only smoking cessation codes to become standard. The AMA will convert both G0375 and G0376 to CPT codes, which will be available Jan. 1, says Alan L. Plummer, MD, at Emory University School of Medicine in Atlanta. "The number of yearly visits allowed for these new codes has yet to be determined," he adds.

Plus: The new codes will be time-based. The current G codes, which Medicare restricts to patients who have documented tobacco dependence (305.1, Tobacco use disorder) and either a co-morbidity that smoking complicates or use a prescription drug that may lead to an adverse reaction/negative outcome as a result of continued smoking, include:

- G0375 -- Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

- G0376 -- ... intensive, greater than 10 minutes.

Example: A 16-year-old with worsening asthma visits the nurse for smoking cessation assessment and returns in one month for intervention beginning a cessation program. In 2008, if a payer doesn't cover 96150 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient; initial assessment) and 96152 (Health and behavior intervention, each 15 minutes, face-to-face; individual) for this encounter, you could use a smoking cessation counseling code based on encounter time.