Wiki PHONE CONSULTS -NEW PATIENT VS ESTABLISHED PATIENTS

[lbarog101@gmail.com]

Hello,
My company would like to start billing for our short phone conversations and emails. 99441-99443, 99421-99423. Here is our situation. We provide free phone consults to patients. However, when they come for surgery, we do a full H&P and bill a new patient code with surgery. My question is the patient considered a new patient or established after consult? The emails and phone conversations are endless. My surgeones would like to get paid for their time. Also, is any one using these codes? How did you notify patient to get their permission to bill for these codes? Any help appreciated.

 

[jkyles]

Hi there, I'm assuming that you have payers that cover these codes.

I suggest reading the full descriptor and guidelines in your CPT manual. The manual makes it it clear that the services are for established patients, the patient has to initiate the call or contact and there are time limits on when you can report the codes separately.

 

[thomas7331]

I agree, you can't bill these codes for new patients, but if you're giving these phone consultations for free, then I guess that's not an issue. The patient becomes established only after a face-to-face encounter. The phone and digital services are designated as non-face-to-face services and will not establish the patient, so it's appropriate to bill the new patient code for the patient's first in-person visit. After than you can bill the telephone or digital services if and only if the conditions given in the code descriptors have been met.