Wiki Telephone services confusion

[costa206]

I work for a PACE elder care company and we are starting to report encounter data for the first time. We run full-service clinics involving physicians, CRNP's, PT/OT, RN's, dietitians and social workers, among other disciplines. One of the major points of confusion we have had in developing a cross-disciplinary coding system is with the reporting of telephone services, specifically with the guidelines that the service cannot originate "from a related E/M (or assessment and management) service provided within the previous 7 days or leading to an E/M (or assessment and management) service. . .within the next 24 hours. . ." For example:

(1) If a patient talks to the RN about a problem that had been assessed by the physician less than a week before, can this be reported as a telephone service with codes 98966-98968, or is this included in the original assessment?

(2) Similarly, if an MD speaks to a patient within seven days of another MD's assessment, can the second MD report a telephone service?

(3) Finally, if the result of a phone call is that the RN tells a patient to come into the clinic the next day to see the physical therapist (or MD or dietitian), would this qualify as a telephone service since the appointment would be with someone other than the nurse?

Any help with this would be greatly appreciated.

Ronin Costa, CPC

 

[costa206]

Ronin Costa CPC

Even if you don't have specific knowledge of this, can anyone suggest a good resource that might explain telephone services in more detail than the CPT book? We were thinking about possibly purchasing the CPT assistant archives, probably on the CPT app. Does anybody who has used this recommend this as a resource for the questions that we had?

 

[mitchellde]

Even if you don't have specific knowledge of this, can anyone suggest a good resource that might explain telephone services in more detail than the CPT book? We were thinking about possibly purchasing the CPT assistant archives, probably on the CPT app. Does anybody who has used this recommend this as a resource for the questions that we had?

The CPT assistants are historically a great resource although I have not used them for a couple of years.
To answer your issues:
1. No you may not bill the 98966-68 for a problem addressed in a visit less than a week before
2. No, just because it is a different MD it does not change anything.
3. You cannot bill the phone call if the result is a visit with anyone in the office.
Also remember the patient is the one that must initiate the call.

 

[JuarezD]

Noridian webinar

Hello,

Not sure what state you are in but Noridian is having a webinar at 1pm pt time. I am a coder for an FQHC facility and am very much confused as to what code to use for telemedicine. Guidelines I've came across online are very much confusing.

 

[costa206]

To answer your issues:
1. No you may not bill the 98966-68 for a problem addressed in a visit less than a week before
2. No, just because it is a different MD it does not change anything.
3. You cannot bill the phone call if the result is a visit with anyone in the office.
Also remember the patient is the one that must initiate the call.

Thanks, Debra, I really appreciate your feedback!

 

[costa206]

Thanks for the suggestion, Juarez! Did the webinar help you?