Primary Care Coding Alert

Question: Although our physicians sometimes spend a lot of time managing patients over the phone, we do not use telephone codes 99371-99373 because Medicare and most private payers do not reimburse these codes. Some insurance companies, however, do pay for the phone codes. Is it fraudulent to bill these codes only to the patients' insurance companies that we know will reimburse them, or should we bill all patients alike regardless of carrier? California Subscriber Answer: Billing the phone codes (99371-99373, Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals) to some insurance companies and not others is perfectly legal. But if you use this method, and the insurance company denies the claim, you are obligated to bill the patient. To bill the insurance company and not the patient is considered fraudulent.

If an audit reveals that you did not attempt to collect from the patient after a denial, you could face financial penalties or be kicked out of the insurance plan.

Do not bill the telephone codes to Medicare, because it considers them bundled. Some private payers follow Medicare's lead and bundle the codes as well. Practices don't always know in advance whether the carrier bundles them, so if you accidentally bill them to such a payer, do not, in turn, charge the patient after the denial.

You should also consider the public-relations issue. Because you will sometimes be billing patients instead of insurance, you must always weigh the pros and cons and the effect it may have on your reputation in the community. If no other practices are doing it, charging patients for phone calls can harm the image of your practice.

If your doctors spend a lot of time managing patients on the telephone, negotiate a reimbursement policy with your insurance companies during the next contract negotiation. When you bill phone codes, make sure the physician documents the call in detail.

Following the basic rules of phone codes will increase your chances of reimbursement: Do not bill phone codes when the patient calls in; only when the doctor calls the patient. Do not use telephone codes when a nurse or physician assistant calls a patient; only if the doctor makes the call. Do not use the telephone codes when calling in a prescription.

Do not include phone time in the next office visit. When coding on the basis of time, the time included in the E/M visit must be face-to-face time only. If the physician documented the phone call, the conversation can become part of the history in the documentation of the E/M visit, but it is not likely to change the level of service.