Urology Coding Alert

Question: Our urologist spent 20 minutes during office hours on the phone providing advice and reassurance to an established patient who had frequent, painful urination. Can we be reimbursed for this time?

Virginia Subscriber

Answer: CPT includes three codes to report physician-to-patient telephone calls: 99371 (Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals [e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists]; simple or brief), 99372 ( intermediate) and 99373 ( complex or lengthy).

These codes apply only if the physician contacts the patient, and may not be charged for incoming calls. Proper coding suggests that you should track and report all services provided, but be aware that the CMS Physician Fee Schedule assigns no relative value units for 99371-99373, and Medicare will not reimburse for these services.

However, the time spent on the phone may be considered when deciding on an E/M level for a subsequent office visit as long as the conversation is properly documented. For instance, if a patient with frequent, painful urination calls asking advice (as suggested in your question) and, after 10 minutes of questioning, the physician determines that an immediate office visit is warranted, the content of the telephone conversation may become part of the E/M evaluation.

Some third-party payers may pay for telephone consults, or you may negotiate with your third-party payers for reimbursement. An effective bargaining tool is to provide a cost/benefit analysis that will prove to the insurer that allowing reimbursement for telephone consults would result in fewer office visits, thereby saving the insurer money.