Primary Care Coding Alert

While FPs spend a lot of time on the telephone with patients, most do not bill telephone codes 99371-99373 because Medicare and many private payers do not reimburse them. But if the physician documents the content of a telephone call, the practice should bill for it regardless of the payer, coding experts say. 
 
Some FPs report the telephone codes only to insurers who pay for them and write off the same service for patients whose payers do not reimburse the codes. "Although this practice is not fraudulent, it is unfair to the insurance companies," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. FPs should report telephone codes to all insurance companies, she says.

Coders can bill phone codes only if the physician calls the patient. Although family practices receive many incoming telephone calls, these are not billable. Report 99371 (telephone call by a physician to patient or for consultation or medical management ... simple or brief) when the doctor calls the patient to report test results or to alter previous instructions for example, if the FP needs to adjust the dosage of a patient's medication due to new lab results.
 
Code 99372 ( intermediate) is used for a longer telephone discussion of test results or coordination of care. An FP calling a patient to disclose test results of a more serious disease, such as hepatitis C, may need to spend more time on the phone explaining the illness and setting up care management. A conversation like that warrants 99372.
 
For long phone calls, use 99373 ( complex or lengthy). These calls usually involve counseling an anxious patient, or a detailed discussion with family members regarding a seriously ill patient. For example, if an FP calls a patient to report that he or she tested positive for HIV, the patient would probably be distraught and may require a lot of counseling that justifies 99373. Typically the FP would call the patient and have the individual visit the office. However, if the patient is out of town, the FP might call immediately to notify the person.    
 
"Although many payers don't pay for the telephone codes, the number that do reimburse is probably going to increase in the future," says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa. "These codes didn't even exist a few years ago, and now phone calls come up relatively frequently. If you put a note in the chart, you should try to bill for the service."

Because telephone codes are not always reimbursed, coders should know when not to bill them to decrease the chances of denial:
 

Do not bill phone codes when the patient calls in; only when the doctor calls the patient.
 

Do not use telephone codes when a nurse or physician assistant calls a patient; only if the doctor makes the call.
 

Do not use the telephone codes when calling in a prescription.
 

Do not include phone time in the next office visit.

Some FPs try to factor time spent on the phone with a patient into that patient's next E/M visit. But this is incorrect coding. Time included in the E/M visit must be face-to-face time only. If the physician documented the phone call, the conversation can become part of the history in the documentation of the E/M visit, but it is not likely to change the level of service.