Wiki 99443-Prolonged Tele-Visit

[tadapoof]

Good afternoon. I have a provider who had a phone visit scheduled for a patient to refill chronic meds and to help fill out several disability forms. The provider spent 1 hr. and 23 minutes discussing chronic conditions and medication adjustments and 30 minutes were spent helping patient with paperwork. I know that the provider can't bill how she wanted which was 99443 + G2211 + 99417 x 4 (yes she gets code happy ) and she's a thorough documenter.
I think that she will have to eat the additional time spent due to the visit being audio only. I know that providers want to bill and get paid for their time spent with patients, but how do I explain this?

 

[natashalage]

Sorry, I’m not an expert, but what I heard in our group that the maximum code that you can bill for a phone E/M is 99443, even though a provider spent more than 30 minutes.

 

[bhardwajv]

The provider can only bill 99443 even if the time is greater. When the audio-only CPT codes were created, it was likely not anticipated that there would be occurrences of such prolonged audio-only E/M visits. Even If we look at the prolonged service codes we didn't get any benefit from them as they are all add-on codes and 99443 does not have any add-on code for prolonged services. You have to bill 99443 in this case.