Primary Care Coding Alert

Question: To code a very involved phone call, may I append modifier -22 to 99371? For instance, the patient is overweight and can't get out of bed. So, a family physician  refilled the patient's prescription over the phone, gave directions on how to use the medication and consulted with the patient's therapist.

Connecticut Subscriber Answer: You shouldn't append modifier -22 (Unusual procedural services) to E/M codes. Modifier -22 is only for use with procedural services.

The telephone codes are based on complexity of care. To designate a "very involved" or complex phone call, you should report a higher-level code, for instance 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]).

Adjusting the patient's prescription over the phone rather than initiating therapy may warrant using a lower-level code, such as 99371 (... simple or brief [e.g., to report on tests and/or laboratory results, to clarify or alter previous instructions, to integrate new information from other health professionals into the medical treatment plan, or to adjust therapy), for the patient call.

Code 99372 (... intermediate [e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone, to discuss test results in detail, to coordinate medical management of a new problem in an established patient, to discuss and evaluate new information and details, or to initiate new plan of care]) may appropriately describe the coordination of care involved in a physician-to-therapist call.

That being said, many private payers, as well as Medicare, don't cover telephone-call codes. If you can show an insurer the cost savings that telephone calls provide over office visits (or, in this case, home visits), you may successfully negotiate 99371-99373 coverage into your contract. - Answers to You Be the Coder and Reader Questions provided by Jaime Darling, CPC, certified coder for Graybill Medical Group, which has nine family physicians, in Escondido, Calif.; Kent J. Moore, healthcare financing and delivery systems manager for the American Academy of Family Physicians in Leawood, Kan.; Arlene Morrow, CPC, CMM, CMSCS, a coding specialist and consultant with AM Associates in Tampa, Fla.; and Julia M. Pillsbury, DO, FAAP, a private practice physician in Dover, Del.