Podiatry Coding & Billing Alert

Question: We had a new patient come into the office, and the physician did a complete workup, which resulted in a level-three new patient E/M visit. Later in the week, the physician called the patient to see how he was doing and to discuss any questions the patient had. The physician spent 22 minutes on the phone with the patient. The physician believes that since CPT^® offers telephone codes, we should report them, but I don’t think this service is billable. Who is correct?

Massachusetts Subscriber

Answer: You are correct. This service is not billable as a telephone E/M service.

CPT^® does have three telephone service E/M codes, and they are as follows:

• 99441, Telephone evaluation and management service by a physician or other qualified health » care professional who may report evaluation and management services provided 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; 5-10 minutes of medical discussion
• 99442, … 11-20 minutes of medical discussion
• 99443, … 21-30 minutes of medical discussion.

The physician may believe that reporting 99443 seems like the right choice because he spent 22 minutes on the phone discussing the patient’s care. However, according to CPT^®, if you report any of the above codes, you must make sure the situation meets the following requirements:

• The patient must be established.
• You cannot report 99441-99443 if the telephone call ends with the decision for the physician to see the patient within 24 hours or at the next available urgent visit appointment. In this case, CPT^® considers the call part of the pre-service work of the subsequent E/M service, procedure, and visit.
• The phone call cannot refer to an E/M service the physician performed within the previous seven days or within the postoperative period of the previous procedure.

In this situation, since you cannot report 99441-99443 within seven days of an E/M service, you cannot bill for this telephone call.

Remember: Before submitting these codes, it’s a good idea to check with your payer. Most do not recognize these codes and thus will reject or deny the claim. You may want to develop a process to alert the patient about possible denial and responsibility.