Neurology & Pain Management Coding Alert

Question: Our physician often makes post-procedure phone calls. Can we code that service, and if so, how?

Indiana Subscriber

Answer: CPT offers six codes to report telephone services: 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional ...) and 99441-99443 (Telephone evaluation and management service provided by a physician ...).

Caveat: Just because you use these codes does not mean you can report these codes -- or that you will get paid for phone services if you do bill the codes. In general, thoroughly review the CPT guidelines before coding telephone service calls. Many elements determine whether you can even code phone services, including the following:

• To report 99441-99443, your neurologist must be the one providing the telephone service. If a qualified nonphysician healthcare professional, such as a therapist, handles phone calls from patients, you should use codes 98966-98968 to report these. Phone calls often fall into exempted periods when you cannot bill them separately, including: when the neurologist sees the patient within the next 24 hours; when the call is within seven days of a previous E/M service; or if the call is within a postoperative period from a previous procedure/surgery.

• The patient must be the one who initiates the phone contact in order to report 98966-98968 or 99441-99443. In your example you state that the neurologist is calling the patient after a procedure. Therefore, you cannot report those codes.

Even if you meet all the coding requirements, not all payers will reimburse for telemedicine services. For example, the Medicare Physician Fee Schedule (PFS) does include relative value units (RVUs) for 98966-98968 and 99441-99443. CMS assigns a status indicator of "N" or non-covered for both codesets. Some payers may pay, but Medicare does not, so check with the individual insurance companies first.

Warning: Patients might react negatively to seeing unexpected charges for phone service that you billed to them or their insurance. Consider a written disclosure either in a brochure or your new patient welcome package that informs the patient of your phone service billing policy upfront.

Good practice: Include as much information as possible -- such as the date, call length, reason for the call, and any recommendations provided -- and file it in the patient's chart.