Wiki Time based coding for email/ phone encounters?

[daniel.maher]

Hello,

My practice does a lot of phone/ email encounters that usually don't get reimbursed. I think BCBS is the only provider who has paid us for the 99444 code. We spend so much time coordinating care without actually seeing patients for free because of this.

That said, is time based coding without direct face to face contact (99358, 99359) a valid workaround? These codes are in our contracted fee schedules.

Let's say a patient calls or emails, and a doctor diagnoses the patient with a throat infection and prescribes a z-pack. Or a patient calls or emails with severe hand pain and we refer them to a rehab specialist.

As long as the time is documented, can we bill this?

Thanks,

Daniel

 

[cheermom68]

I highly doubt that the provider is spending the minimum 30 minutes required for the situations that you mentioned above. Read the CPT book section preceding those codes very carefully before using. The service also needs to relate to a service or patient where face to face patient care has occurred or will occur and relate to ongoing patient management. So in other words, the patient needs to have recently seen or will see the doctor for management of that particular problem. Most acute instances such as what you described will not meet that criteria nor the time criteria. Most offices either require the patients to be seen for these types of problems, or perform the phone encounter as a courtesy. I think that these codes are more intended for more complex issues that require coordination of care, extensive reading of records, contact with other providers, etc.

 

[hbeard]

Look at 99441-99443, 98966-98968 for non face-to-face services, as long as they are established patients and haven't been see in the previous 7 days or will be seen in the coming 24 hours, these codes can be billed based on time. Be sure that what is discussed with the patient and time spent is documented. I inform our patients first that this could be a non-convered service and they may have to pay out of pocket, which could cost them more than their copay! Not many insurances are actually paying benefits for these codes though.

 

[mitchellde]

Hello,

My practice does a lot of phone/ email encounters that usually don't get reimbursed. I think BCBS is the only provider who has paid us for the 99444 code. We spend so much time coordinating care without actually seeing patients for free because of this.

That said, is time based coding without direct face to face contact (99358, 99359) a valid workaround? These codes are in our contracted fee schedules.

Let's say a patient calls or emails, and a doctor diagnoses the patient with a throat infection and prescribes a z-pack. Or a patient calls or emails with severe hand pain and we refer them to a rehab specialist.

As long as the time is documented, can we bill this?

Thanks,

Daniel

The 99358-59 will not work for the circumstances you have described as stated above these must be a min of 30 minutes and must be an extension of a pervious encounter.
My question though is why are you not billing the patient if the payer denies the phone call? The patient requested the service by calling, why did you not inform them at that time that in the envent the payer does not pay they will be expected to pay?
If a patient argues regarding the possibility of paying for a phone call then make an appointment for them to come in to the office. Being able to be treated via the phone or e-mail is a privilege not a right!
if the patient refuses to pay the bill then when they call again do not let them be put thru to the provider tell them they must make an appointment instead untill the phone call is paid.
You can control this you just need to work at it.