Primary Care Coding Alert

Question: A suicidal patient whom our staff is treating for depression calls our family physician. After the FP calls the patient and her  husband three times, the physician contacts the sheriff's department for transportation and arranges for the patient's psychiatric hospital admission. Although the FP never sees the patient face-to-face, she spends a total of 45 minutes on the patient and her case. How should I report the service?

California Subscriber

Answer: Use telephone call code 99373 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists]; complex or lengthy [e.g., lengthy counseling session with anxious or distraught patient, detailed or prolonged discussion with family members regarding seriously ill patient, lengthy communication necessary to coordinate complex services of several different health professionals working on different aspects of the total patient care plan]).

The physician-to-patient call involves complex or lengthy counseling of a distressed patient and prolonged  discussion. The FP also coordinates transportation and admission and talks to healthcare professionals, the sheriff's office and psychiatric hospital staff.

Some insurers, such as Medicare, won't separately reimburse telephone calls. If the patient's payer considers 99373 a noncovered service, bill the patient.

You may also code the hospital admission if the FP performs the initial face-to-face encounter. If the FP sees the patient the next day and performs the patient's first inpatient E/M service, submit 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...). Choose the appropriate-level hospital code based on the service level the FP performs.