insurance call E/M billing

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Hello, Could I bill an E/M prolonged service code that is 15 minutes long and on a different day other than the E/M? I have a doc calling an insurance company to appeal a denied test that the doctor ordered. I see a nonface to face code of 99417 but it has to be on the same day and the insurance call is documented as the next day? Any ideas?
 

lcolborn

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This is my 2 cents on this, and please hear me out..., this is just my thoughts on this/ don't shoot :) . Is the Doctor calling the insurance company to have the test ordered
for medical necessity be covered or the doctor is calling for peer to peer to get the test approved? To get the test approved, is not billable for a prolonged
service , this is pre- certification issue and or a part of billing , not medical per say for the patient care. Now, if the doctor is calling to get the test paid or
covered does not justify an extended E/M either .......
Perhaps someone have any input on this, and I'm curious to see.
 
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Thanks for replying. The doctor saw the patient, wanted authorization for an MRI, was denied and told to do regular/other treatment for 3 months. Patient comes back 3 months later, still not better so doctor was calling insurance to appeal their denial of MRI. Unfortunately the call took place the next day after the E/M visit so I could not count that time for the E/M. Is there any way to bill his appeal phone call? I really felt like it could go under "time spent" non face to face as we can count that now if it is on the same day of service, right? I am referring to page 8 in CPT book regarding total time of encounter, but I do see "does not include time normally performed by clinical staff" so depending who calls the insurance.
 
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csperoni

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I personally would not count the clinician's time getting an authorization, regardless of the date.
Per AMA's 2021 guide, it is listed neither in included activities nor non-included activities. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
However, as you noted, typically other staff will perform that activity and there is the clause "includes time in activities that require the physician or other qualified health care professional and does not include time in activities normally performed by clinical staff." That would be a difficult argument to make that the physician was required. In our practice, administrative staff typically obtain the authorizations. In the rare instance a peer-to-peer review is required, it is scheduled by our admin staff and the clinician is personally on the phone for maybe 5 minutes, if that.
 
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