Pulmonology Coding Alert

Question: Another office just informed us about getting paid from their contractor for telephone calling codes. My physician would like to start using these codes as well. Does Medicare pay for telephone calls?

Washington Subscriber

Answer: No, Medicare will not pay for patient consultations performed over the phone as the agency considers telephone call codes 99441-99443 (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...) to be non-covered services. Other payers may, however, so you will have to check with them on a case by case basis.

For example, PriorityHealth, a leading insurer in Michigan, states that it will reimburse for telephone visits, e-visits and hosted visits when requirements are met and services are contracted. For more info, visit this link http://www.priorityhealth.com/provider/manual/billing-and-payment/services/phone-and-e-visits

When you bill for telephone services, you would typically do so using two sets of codes: 99441-99443, which are for phone services by physicians; and 98966-98968 (Non-face-to-face nonphysician telephone services), which are for services by “qualified non-physician healthcare professionals.”

There’s hope: Your physician technically is getting paid for telephone calls made in relation to performed office visits. “The physician work resulting from telephone calls is considered to be an integral part of the pre-work and post-work of other physician services, and the fee schedule amount for the latter services already includes payment for the telephone calls,” according to the Medicare Benefit Policy Manual, Chapter 15, Section 30 (Physician Services), Subsection B, Telephone Services (www.cms.gov/manuals/Downloads/bp102c15.pdf).

The relative value units for office visits include time for work that is spent before and after the visit on items like pulling the chart, reviewing lab results, and calling the patient. Since the fee schedule includes relative values for 99441- 99443, some private and other public payers may pay for the codes, but remember that the guidelines are very specific for reporting these codes. The patient must be established to the practice, must have initiated the call to the physician, and the information discussed cannot be directly related to a visit seven or less days before the phone call. Also, the call cannot take place when the patient makes an appointment to see the physician regarding the health issue within 24 hours.