Oncology & Hematology Coding Alert

Use time, service type and care complexity to recoup pay Is your oncology practice not reporting phone calls because of coding and compliance concerns or reimbursement issues? Then you could be costing your practice as much as $50 a day.

If you want to stop giving telephone calls away as a gift, follow this expert advice for tackling your most significant problems regarding coding for this service. 1. Difficulty Determining the Complexity Level Even though the telephone-call codes aren't time-based, you can easily distinguish between the three call types by the code descriptions, says Julia M. Pillsbury, DO, FACOP, FAAP, a physician practicing in Dover, Del.:

 Simple: 99371, Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other healthcare professionals (e.g., nurses, therapists, social workers, nutritionists, physicians, pharmacists); 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)

 Intermediate: 99372, ... intermediate (e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone, to discuss test results in detail, to coordinate medical management of a new problem in an established patient, to discuss and evaluate new information and details, or to initiate new plan of care)

 Complex: 99373, ... complex or lengthy (e.g., lengthy counseling session with anxious or distraught patient, detailed or prolonged discussion with family members regarding seriously ill patient, lengthy communication necessary to coordinate complex services of several different health professionals working on different aspects of the total patient care plan). Just remember to report the following telephone code in these instances:

99371. Use the simple or brief code when you call a parent to:
 report test results
 clarify or alter prior instructions
 integrate new information
 adjust therapy.
 
99372. Report the intermediate telephone-call code when you:
 advise or coordinate established patient care with healthcare professionals
 initiate therapy that can be handled by phone.
 
99373. Assign the complex or lengthy code for:
 complex or lengthy counseling or care coordination
 prolonged discussion. 2. Coding Calls Could Raise a Red Flag As long as you properly document telephone care, you shouldn't worry about not coding a service merely because a payer could scrutinize it.

The HHS Office of Inspector General is targeting modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) claims, but that shouldn't stop you from reporting telephone services.

The problem is, however, that CPT offers no guidance regarding documentation for reporting telephone calls, Pillsbury says. Therefore, she recommends when billing for a call to [...]