Eli's Rehab Report

Published on Fri Jul 24, 2009 PDF

Question: My outpatient pediatric SLPs spend a lot of time on the phone talking to parents about care management issues. Parents don't need to come in for this, and I'm wondering if I can bill for this time with the new telephone services CPT codes.

Answer: There are new telephone services codes available as of CPT 2008. They are

• 98966 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion);

• 98967 (...11-20 minutes of medical discussion); and

• 98968 (...21-30 minutes of medical discussion).

However, Medicare does not reimburse for these codes, and I am not aware of any state Medicaid program or third party payer that reimburses for these codes either. That said, you might consider encouraging parents and their children to schedule an appointment with your SLPs in the office so that you can bill the time spent counseling.

There's a chance you could then use the care/home management training CPT code, 97535. Just make sure your documentation describes the skilled counseling you provided, and pay close attention to your payer guidelines regarding that code.

Also be aware that upon Medical Review auditors might scrutinize the use of that code for counseling the parent and child.

-Reader Questions were answered by Rick Gawenda, PT, director of PM&R at Detroit Receiving Hospital and President and CEO of Gawenda Seminars.