Pediatric Coding Alert

If you're not reporting phone calls because of coding and compliance concerns or reimbursement issues, you could be losing as much as $50 a day.
 
To stop you from giving telephone calls away as a gift, experts tackle 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 tell the differences among the three calls, says Julia M. Pillsbury, DO, FACOP, FAAP, a pediatrician at the Center for Pediatric Medicine 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:
 
Code 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.
 
Code 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.
 
Code 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 Office of Inspector General  is targeting modifier -25 claims, but that shouldn't stop you from reporting telephone services.
 
The problem is, however, that CPT offers no guidance [...]