Pediatric Coding Alert

Question: A patient called during the weekend and left a message for our pediatrician asking for phone care. It was seven days after her previous related E/M. Because she left the message on the office machine on a Sunday, we didn’t get the message until Monday (day eight). Can we bill for that phone call?

Codify Subscriber

Answer: You can report the phone call eight days after the related E/M service with the phone care codes (99441-99443, Telephone evaluation and management service provided by a physician to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment ...). The charge is possible because it is not within the seven days of the previous E/M. It is the date of the telephone service, not the date the patient requested the service, that is relevant in making this determination.

Beware: Make sure you are not gaming the system by intentionally responding outside the time frame. As you indicate, you could not respond to the call within the seven days because you received the request when the office was closed. Also keep in mind that not all payers will reimburse for these services.