Pediatric Coding Alert

Question: When a nurse practitioner calls a patient instead of the pediatrician, can I use a telephone call code?


New Jersey Subscriber
Answer: The answer depends on your state scope of practice laws. Best bet: Check your state's eligibility and the payer's policy.

Why: For purposes of CPT, nurse practitioners (NPs) are considered eligible for "physician"- stipulated codes. So a telephone call by an NP counts as a physician call and may be reported with 99371-99373 (Telephone call by a physician ...) in 2007 and with 99441-99443 (Telephone evaluation and management service provided by a physician ...) in 2008 persuant to CPT coding guidelines.

Don't overlook other traditional "physician" services that NPs maybe able to furnish. For instance, an NP may be able to report higher-level office visit codes (such as 99214, Office or other outpatient visit for the E/M of an established patient) even though the codes specify "physicians typically spend ..." You may even count NP-provided immunization administration counseling toward 90465-90468 (Immunization administration younger than 8 years of age ... when the physician counsels the patient/family ...).

And NPs may be able use physician team conference codes, such as 99361 (Medical conference by a physician ...) in 2007 and 99367 (Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician) in 2008.