Primary Care Coding Alert

Question: Services such as phone calls to patients, filling out forms, and coordinating the patient’s care have become quite time-consuming for our physicians. Does CPT® include any procedure codes for these types of case management services?

Oregon Subscriber

Answer: Good news: CPT® does include an increasing number of codes that could apply to your situation.

First, consider the 99441-99443 series (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 …) for telephone E/M services if you perform them. Remember, however, these codes are not simply for calling another clinician to chat about a patient’s condition. Rather, they are used for actual E/M services provided to the patient and performed over the phone.

Other case management codes are listed under 99363-99368. This series includes codes for medical team conferences, whether the patient is present (99366) or not (99367-99368). As for completing forms, you can report 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form).

Caveat: Each of these codes has special reimbursement requirements from insurers, if they are payable at all. Whether they are reimbursable will depend upon your specific insurance contract. Often, physicians will roll coordination of care and related services into a patient’s E/M code. In addition, don’t forget that you can select an E/M code based on time spent if counseling or coordination of care comprises at least 50 percent of the visit.

Looking ahead: CPT® 2013 will introduce new codes related to coordinating a patient’s care over a month-long period. Watch for more details on 99487-+99489 (Complex chronic care coordination services …) in future issues of Family Practice Coding Alert.