Follow up of normal labs

Messages
13
Best answers
0
The physician keeps billing visits for follow up of normal results.
Results was done over the phone.
Shouldn’t this be consider abuse?
No medical necessity established here.
There is nothing else being done besides saying the results were normal.
Where can i get this info in writing?
 

thomas7331

True Blue
Messages
3,239
Best answers
10
What exactly is the provider billing, and what is documented in the record? Whether or not a service is medically necessary is something a clinician would need to determine after reviewing the individual record. But for coding purposes, the CPT codes for phone E&M service (99441-99443) specifically states in the code description "not originating from a related E/M service provided within the previous 7 days" so that cannot be billed for a call to follow up on labs if the patient was seen by the provider in the previous week. Is this what the provider is billing for the follow-up?
 
Messages
13
Best answers
0
the lab was performed months prior.
labs came back normal.
so physician calls patient back. provider is billing 99212. nothing else was discussed besides f/u with 1 year.
 

csperoni

True Blue
Messages
1,011
Location
Selden
Best answers
3
This seems wrong for a variety of reasons. Let's just take medical necessity out of the picture for a moment. Let's also not get into why it took the provider months to give the patient results.
1) Telephone services would be 99441-99443 not E/M
2) 99212 requires at least 10 minutes. I find it difficult to believe it took the provider 10 minutes to say "Your tests were all normal. We'll see you in a year."
 

thomas7331

True Blue
Messages
3,239
Best answers
10
I agree, 99212 is inappropriate in this situation. In additional to not being a correct code for a phone call, it requires a chief complaint, which isn't supported by normal labs, so would require some additional reason from the patient for the 'visit'. Also, 99212 is an E&M service - simply telling a patient that their lab results are normal, in and of itself, doesn't involve any evaluation or management of the patient - none of the elements of history, exam, MDM, counseling or coordinating care. The correct codes for a telephone service are 99441-99443, however, per CPT instructions, these codes may only be used for 'patient care initiated by an established patient', not initiated by the provider. Lastly, I'd just note that CMS has patient consent requirements for some telehealth or virtual services. If there is no documented consent from the patient that these phone call will be billed to their insurance, the provider should not be doing it.
 
Last edited:
Messages
13
Best answers
0
I agree, 99212 is inappropriate in this situation. In additional to not being a correct code for a phone call, it requires a chief complaint, which isn't supported by normal labs, so would require some additional reason from the patient for the 'visit'. Also, 99212 is an E&M service - simply telling a patient that their lab results are normal, in and of itself, doesn't involve any evaluation or management of the patient - none of the elements of history, exam, MDM, counseling or coordinating care. The correct codes for a telephone service are 99441-99443, however, per CPT instructions, these codes may only be used for 'patient care initiated by an established patient', not initiated by the provider. Lastly, I'd just note that CMS has patient consent requirements for some telehealth or virtual services. If there is no documented consent from the patient that these phone call will be billed to their insurance, the provider should not be doing it.
Great! thank you so much for this information.
 
Top