Pulmonology Coding Alert

Question: To cut down on the number of patients in our office during the COVID-19 pandemic, our pulmonologist has been performing telehealth calls for patients requiring only an E/M visit. Can you please explain the difference between 99441-99443 CPT^® codes?

New Jersey Subscriber

Answer: You will find three differences between the CPT^® codes and their Medicare-recognized equivalent HCPCS code, G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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; 5-10 minutes of medical discussion).

When you examine the descriptors of the CPT^® codes, you’ll notice that each one has a different time range for medical discussion:

• 99441 (Telephone evaluation and management service by a physician or other qualified health care profes­sional who may report evaluation and management services provided 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; 5-10 minutes of medical discussion)
• 99442 (…; 11-20 minutes of medical discussion)
• 99443 (…; 21-30 minutes of medical discussion)

Codes 99442 and 99443 allow for longer calls, so the physician and patient can discuss procedures, symptoms, and treatment plans more in-depth. The descriptor for G2012 calls out a “technology-based service,” which permits the use of a computer to conduct the telehealth visit virtually.

Lastly, CPT^® guidelines preceding 99441-99443 state the patient or guardian must initiate the call, while the physician or qualified healthcare professional (QHP) must initiate a G2012 telehealth visit.

Please note: Despite these codes being in existence prior to the public health emergency (PHE), Medicare did not recognize them for reimbursement. Medicare allows the use of the 99441-99443 for phone-only telehealth visits during the pandemic only. Medicare is currently gathering data about telehealth to determine the appropriateness of telehealth post-pandemic.