Pediatric Coding Alert

Question: Our pediatrician saw two patients on Friday who subsequently had increased bilirubin levels over the weekend. On Saturday, the physician ordered phototherapy, and discussed the lab results with the parents over the phone. The patients followed up in the office on Monday. How can we bill for the phone management on the weekend?

Minnesota Subscriber

Answer: According to CPT rules, you cannot report the telephone management codes (98966-98968) if the patient was seen by the physician for a related E/M service within the previous seven days or if the phone call leads to an E/M service or procedure within the next 24 hours or the next available urgent visit appointment. It sounds like your patients were seen both before and after the phone call, which precludes you from reporting one of these codes.

However, you might consider reporting code 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) for your physician's time on the phone.  

This is a non-face to face E/M code for services performed that are related to an accompanying E/M service. The physician needs to document the time he spent on the phone, which must exceed 30 minutes of cumulative time on a given date of service.