Telephone and On-line Services: How Much Is Your Practice Losing?

As background, CPT 1995 introduced three codes to enable physicians to charge for telephone management services. With the introduction of these codes, I designed a Pocket Coding Pad to be used as a tool by physicians to help capture these services and ensure they were billed.

Nine years later in July, 2004, a Category III code was introduced to allow physicians to also bill for on-line services. Category III codes are temporary codes for emerging technology/services/procedures. Naturally, I supported this code as well and added it to the Pocket Coding Pad.

This year, CPT 2008 has readdressed telephone management and on-line services. The old codes have been deleted and replaced with more detailed descriptions of what the services entail and the recommended time guidelines.

What is really significant is that in the past, only physicians who were directly involved with these services could charge for them. Now, CPT 2008 allows qualified non-physician healthcare providers to bill for these services, too. The three deleted codes (99371, 99372 and 99373) were described as brief, intermediate and complex. The vague descriptors prompted many questions about the utilization of the codes and necessary documentation to support the services.

The new and revised codes for physicians are found in the Evaluation and Management Section of CPT 2008 under "Non-Face-to-Face Physician Services." Telephone management is now defined as non-face-to-face evaluation and management provided by a physician using the telephone. These codes are used to report episodes of care by the physician when the care is initiated by an established patient or guardian of the patient.

Telephone Services: 99441 5-10 min. 99442 11-20 min. 99443 21-30 min.

On-Line Medical Evaluations: 99444

The new codes enabling qualified non-physician healthcare providers to bill for telephone and on-line services are found in the Medicine Section of CPT 2008 under "Non-Face-to-Face Nonphysican Services."

Telephone Services: 98966 5- 10 min. 98967 11-20 min. 98968 21-30 min.

On-Line Medical Evaluation: 98969

There are a few common sense limitations for utilizing the codes and they are outlined in both sections referenced above:

1. If the call results in a decision to see the patient within 24 hours or the patient is scheduled for the next available urgent care visit appointment, it is not billable because these services are considered part of the preservice work for the subsequent visit.

2. If the call refers to an evaluation and management service performed by the physician or nonphysician healthcare professional within the previous seven days, it is not billable as it is considered part of the previous E&M service.

3. If the call from the patient is placed within the global period of a past procedure, it is considered a part of the global fee and therefore not billable.

With these guidelines established, there is much more clarity on how and when to bill for telephone and on-line services.

Use the on-line medical evaluation codes to report on-line services provided to an established patient, guardian or healthcare provider. The same common sense parameters listed above for telephone management apply to on-line services. Reportable services encompass the sum of all communications pertaining to the on-line patient encounter (such as telephone calls, prescriptions, etc.) and require a hard copy of the encounter to be stored in the patient chart.

All of the above supports the fact that telephone and on-line patient management is a growing trend. More and more insurance companies are reimbursing for these services and the reimbursement amounts have continued to increase. Physicians should take advantage of the codes provided to them by the AMA to receive the legitimate reimbursement to which they are entitled.

Pocket Coding Pads - The Convenient Billing Tool for Capturing Services. Now available for Physicians and/or Qualified Nonphysician Providers.