Urology Coding Alert

If you're reporting services your urologist provides over the phone, but you're not getting paid, the reason might be one of two things -- you're not following the coding rules surrounding the codes or your payer just isn't paying for those services. Check out these top three denial reasons to ensure that you're not leaving money on the table by misusing these codes.

CPT offers six codes for you to use to report telephone services: 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional ...) and 99441-99443 (Telephone evaluation and management service provided by a physician ...). As evident in the code descriptors, you will choose the proper code to report based on the time a practitioner spends on the telephone with the patient.

Red flag: Just because you have codes to report your telemedicine services, does not mean you'll get paid. While CMS assigns relative value units (RVUs) to 98966- 98968 and 99441-99443, Medicare does not pay for these codes, says Maggie M. Mac, CMM, CPC, CPC-E/M, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla. CPT added 99441-99443 in 2008, and in the Medicare fee schedule the status on these codes has always been "N" or "non-covered," explains William H. Geraghty Jr., CPC-I, revenue manager for GWU Medical Faculty Associates in Washington, D.C. Some private payers may pay you on these codes, however, so check with each of your individual insurance companies.

Beware: If you choose to report these codes for telephone services, be prepared to deal with potential  negative responses. Patients may not like seeing that you're charging their insurance -- or the patients themselves -- for a phone call.

Make sure you restrict the telephone calling codes to the people who don't regularly handle this service. A physician must provide the telephone service if you are going to report these codes, Mac says.

Alternative: If you have a qualified nonphysician healthcare professional, such as a therapist handling phone calls from patients, you can turn to the 98966-98968 codes, Mac says.

Also remember that no matter which of your providers or nonphysician providers talks to the patient, the patient or the established patient's guardian must initiate the contact.

Good advice: Have your urologist or nonphysician provider include documentation of the phone call within the patient's chart -- especially if you expect to bill the patient for the service. The note may include the date of the call, the length of the call, the reason for the call, and any recommendations provided to the patient.

You cannot report telephone service codes if:

• Your urologist sees the patient within the next 24 hours or next available urgent visit.

• The phone call is within seven days of a previous E/M service.

• The phone call is within the postoperative period of a previous surgery.

"I would recommend that anyone considering these services review the CPT guidelines," Geraghty says. "The guidelines indicate there will be limited opportunities when it would be appropriate to bill for these services as it appears most telephone interactions would fall into one of the exempted scenarios."

Example: A new patient comes to your office with flank pain and trouble urinating. Your urologist does a complete workup, resulting in a level-three new patient E/M visit. Later in the week, the doctor calls the patient to see how he is doing, discuss questions the patient has, and recommend a follow-up appointment. Your urologist spends 22 minutes on the phone with the patient.

Although reporting 99443 might seem like the right choice because the urologist spent 22 minutes on the phone discussing the patient's care, the code descriptors for these codes specify that you cannot report 99441-99443 within seven days of a related E/M service. Therefore, you cannot bill for this telephone call.

"If the telephone call is in reference to an E/M service  performed and reported by the physician within the previous seven days (either physician requested orunsolicited patient follow-up) or within the postoperative defined global period of a previously completed procedure, then the telephone service is considered part of that previous E/M post-service work and should not be reported separately," confirms CPT Assistant (March 2008).

Pointer: You can consider the telephone conversation between a provider and patient as a factor when determining a service level for any related follow-up E/M service. If your urologist's documentation showed how the telephone conversation affected the key components of history, exam, and medical decision making (MDM) for the future E/M service, you can fold the phone call time into the MDM for the follow-up service. Then, depending on the documented nature of the presenting problem, level of history, or exam, this additional time may allow a higher-level E/M service.