General Surgery Coding Alert

Question: I recently noticed that CPT contains E/M codes specifically for telephone services. Our surgeon sometimes spends significant time on the telephone with patients. Can we use the telephone codes to gain reimbursement for these services?


Washington, D.C., Subscriber


Answer: You will not receive reimbursement from Medicare for telephone calls as described by 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 -), 99372 (- intermediate -) or 99373 (- complex or lengthy -). The Medicare physician fee schedule database assigns no relative value units to these codes.

And Medicare guidelines specifically instruct carriers, -Do not pay for telephone calls (codes 99371-99373) because payment for telephone calls is included in payment for billable services (e.g., visit, surgery, diagnostic procedure results).-

In other words: Other E/M services the physician provides include telephone calls by the physician to or about the patient, or they are a part of any other procedure that the physician bills. Under no circumstances will Medicare allow separate payment for 99371-99373.

You might consider telephone conversations as a factor, however, when determining an E/M service level, as long as the physician's document shows how the telephone conversation affects the key components of history, exam or medical decision-making.

Most private payers follow similar guidelines, although in limited circumstances you may be able to negotiate payment for some telephone services as part of your contract.

An exception: When a patient is under the surgeon's care as a homecare or hospice patient, telephone calls do contribute to the amount of time you may bill for on a monthly basis.