Wiki Phone visits

[pscott]

I see a naturopath who tried to charge me for a 99213 for a followup
that was done over the phone. I told her that was not legal, but have
since become aware that this is a common practice. Any thoughts on this?

 

[mhstrauss]

I see a naturopath who tried to charge me for a 99213 for a followup
that was done over the phone. I told her that was not legal, but have
since become aware that this is a common practice. Any thoughts on this?

E/M codes in the 99201-99215 range require face-to-face time (depending on the payer, the face-to-face time may be with family instead of directly with the patient, but that's not the issue here), per verbiage in the code description "typically x minutes spent face-to-face with the patient and/or family". There are codes available for Telephone Services (99441-99443), but of course there are requirements to be met: phone call must be initiatiated by patient, must not result in the decision to see the patient within the next 24 hours, etc (see guidelines at the beginning at the Non Face-to-Face Services Section).

It's possibly that she just isn't aware of these codes; try suggesting them to her. Was the charge filed to insurance?

 

[jodismith]

Unless there has been a prior arrangement with the payer to bill using the 99213, I would question this line of billing as well. As already stated, this code is for 'face-to-face' service and not telephonic delivery.
How did she respond when you questioned the code?

 

[pscott]

That's how I see as well. I had told her about the other "phone visit" codes,
but she is still using the other ones. Guess it's time to find a new doctor.
Thanks!