Medicare Compliance & Reimbursement

Question: Does CPT^® include any procedure codes for case management, phone calls to patients, filling out forms, and coordinating the patient’s care? These things have become time-consuming for our practice.

Answer: Yes, CPT^® does include an increasing number of codes that might help you out. First, you should consider the 99441-99443 series for telephone evaluation and management services if you perform them. These codes are not simply for calling another clinician to chat about a patient’s condition. Rather, they are used for actual E/M services provided to the patient and performed over the phone.

You’ll find case management codes listed under 99363-99368. In this series, you will find codes for medical team conferences, whether the patient is present (99366) or not (99367-99368). As for completing forms, you can report 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form).

The only hitch is that these codes all have special reimbursement requirements from insurers, if they are payable at all. Whether they are reimbursable will depend upon your specific insurance contract. Often, physicians will roll coordination of care and related services into a patient’s E/M code. In addition, don’t forget that you can select an E/M code based on time spent if counseling or coordination of care comprises at least 50 percent of the visit.