General Surgery Coding Alert

Question: Can you please give me some information on billing telephone calls 99371 (telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals; simple or brief [e.g., to report on tests and/or laboratory results, to clarify or alter previous instructions, to integrate new information from other health professionals into the medical treatment plan, or to adjust therapy])?

Cindy L. Weberg
Muskegon Surgical Associates, P.C., Muskegon, MI

Answer: Although Medicare will not pay for phone consultations, some commercial carriers may, says Thomas Kent, CMM, principal of Kent Medical Management in Dunkirk, MD. But calls should be billed only in extreme circumstances, Kent adds, such as when the patient is out of town and the physician is attempting to coordinate care in case of an emergency.

Kent says that if the patient asks to talk to the doctor on the phone in the evening, the physician should inform the patient that the call will not be covered by insurance. In many instances, Kent notes, the patient may agree to pay for the call out of pocket. Of course, many physicians consider such calls part of their good will toward their patients.

Kent says, however, that there is a way for physicians to obtain some indirect payment for after-hours calls.
For example, the physician is on call in the middle of the night and has an extensive phone call with a patient. If the doctor takes good notes of the call and those notes are included in the patients chart, and as long as that discussion is relevant the next time the patient visits the physician (say, within the next week or so), the phone discussion can be referenced into the E/M visits history component. This would allow the physician to bill a higher level of E/M service. Of course, the documentation for that E/M visit would need to include a note that references the phone call and the date it was made.