Wiki 99443-Prolonged Tele-Visit

[tadapoof]

Good afternoon. I have a provider who had a phone visit scheduled for a patient to refill chronic meds and to help fill out several disability forms. The provider spent 1 hr. and 23 minutes discussing chronic conditions and medication adjustments and 30 minutes were spent helping patient with paperwork. I know that the provider can't bill how she wanted which was 99443 + G2211 + 99417 x 4 (yes she gets code happy ) and she's a thorough documenter.
I think that she will have to eat the additional time spent due to the visit being audio only. I know that providers want to bill and get paid for their time spent with patients, but how do I explain this?

 

[natashalage]

Sorry, I’m not an expert, but what I heard in our group that the maximum code that you can bill for a phone E/M is 99443, even though a provider spent more than 30 minutes.

 

[bhardwajv]

The provider can only bill 99443 even if the time is greater. When the audio-only CPT codes were created, it was likely not anticipated that there would be occurrences of such prolonged audio-only E/M visits. Even If we look at the prolonged service codes we didn't get any benefit from them as they are all add-on codes and 99443 does not have any add-on code for prolonged services. You have to bill 99443 in this case.

 

[tadapoof]

The provider can only bill 99443 even if the time is greater. When the audio-only CPT codes were created, it was likely not anticipated that there would be occurrences of such prolonged audio-only E/M visits. Even If we look at the prolonged service codes we didn't get any benefit from them as they are all add-on codes and 99443 does not have any add-on code for prolonged services. You have to bill 99443 in this case.

Thanks.

 

[tadapoof]

Sorry, I’m not an expert, but what I heard in our group that the maximum code that you can bill for a phone E/M is 99443, even though a provider spent more than 30 minutes.

Thanks for the response.

 

[sls314]

Adding that 99417 can only be billed as an add-on to one of the CPT codes listed in the Code First note in the CPT book:

Code first applicable E/M service code (99205, 99215, 99245, 99345, 99350, 99483)

Additionally, per this CMS document, G2211 would be used with office and outpatient E/M services 99202-99205, 99211-99215:

https://www.cms.gov/files/document/mm13473-how-use-office-and-outpatient-evaluation-and-management-visit-complexity-add-code-g2211.pdf

I just wanted to give you some additional official sources in case the provider pushed back on not being able to bill those codes for an audio-only visit.

 

[tadapoof]

I appreciate everyone's responses and back-up sources.