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New internet and telephone codes for 2008

By Meera Mohanakrishnan, MSc, CPC
Thanks to the internet, many patients have confidential contact with their health care providers. An online medical evaluation is an evaluation and management (E/M) service provided as a response to a patient’s online inquiry.

Code Changes in 2008

The American Medical Association (AMA) has updated CPT® for online and telephone services. For 2008, Category III code 0074T has been expanded and is now E/M code 99444 Online evaluation and management service provided by a physician to an established patient, guardian, or health care provider not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network. Use 99444 to report a physician’s internet response to an established patient’s inquiry. These services should be documented.
Criteria for using this new code are as follows:

• The established patient or guardian must have initiated the online evaluation request.
• The provider’s response must be timely.
• There must be permanent storage of the encounter (hard copy or electronic).
• The online service can only be reported once during a seven day period for the same problem, but more than one provider can report separate online communication with the patient.
• If an online encounter either follows or results in an office visit on the same day, the online encounter is not separately billable according to CPT®. Instead, the physician would combine the work components of the online service with those of the face-to-face visit and bill one E/M code.
• Do not report 99444 if the provider has billed an E/M service related to the online query within the prior seven days or within the post-op period of a procedure.

This is a stand-alone service, and should not be billed in addition to a related face-to-face visit or procedure, nor should it be reported for pre-service or post-service patient contacts (e.g., telephone calls) for other E/M or non-E/M services.

Check Carrier Reimbursement Policies

Internet communication is a fee-based service and may or may not be reimbursed by insurance companies. While Medicare and some commercial payers will not reimburse this service, there are many that will; and, they have developed their own policies and guidelines. Many insurance companies consider it as incident to or may bundle it into other E/M services or procedures. Others have labeled it as a non-covered service, in which case you are free to bill for it.
Some insurance plans provide secure websites for this type of doctor-patient communication, and payment is automatic. Patient copay or coinsurance is collected and automatically forwarded to the physician when the charges are approved. There are also web-based vendors who provide secure messaging on a fee-for-service basis.

Telephonic Services

Medical care is associated with face-to-face encounters between physicians and patients. In today’s health care environment, physician telephone care represents a growing part of the time spent in caring for patients. Physicians find that routine problems are often safely managed by phone. Sometimes a telephone call from a physician can prevent a costly and unnecessary emergency room visit.
There are three new codes for telephone services in 2008, replacing the existing telephone services codes with new descriptions. The old telephone services codes had a very broad description and were used for a variety of calls from physicians to patients or from physicians to consultants or other health care professionals for medical management. The descriptions of the new codes are below:
99441 Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
99442      11-20 minutes of medical discussion
99443      21-30 minutes of medical discussion
A physician may decide to address simple problems on the phone, such as a patient who wants to come in for a quick visit or requests treatment for a relatively minor concern. As the telephone codes are time-based, it’s important to document the length of the telephone call with other information in the medical record. These codes may only be used for established patients.
Coding guidelines for non-face-to-face E/M services provided using the telephone are:
Use these codes to report physician care initiated by an established patient or guardian of an established patient
Bill a telephone service if another E/M service was not provided within the previous seven days. Since the telephone call codes are considered as the E/M services, they may not be billed if another telephone call was billed within the last seven days.
Don’t use these codes to report non-face-to-face communication between the physician and other health care professionals
See 98966-98968 for telephone services provided by a qualified non-physician health care professional

Telephone Services by Non-physician Providers

The CPT® codes for non-face-to-face assessment and management telephone services provided by a qualified health care professional are:
98966 Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98967      11-20 minutes of medical discussion
98968      21-30 minutes of medical discussion
A telephone call that is part of a pre- or post-office visit or hospital service on the same day should not be coded separately. Instead, the work components of the phone call are combined with those of the face-to-face visit and one E/M code is reported.

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