07-28-2017, 07:27 AM | Community Wiki

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Telephone Encounters

  1. Default Telephone Encounters
    Medical Coding Books
    I did a little research and found there codes in CPT book for Telephone Calls for Patient Management.

    I checked those codes on medicare Fee Schdule and they are not showing up.

    Do Medicare or any other insurance reimburse for then?

    Thank you

  2. #2
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Some do and some do not it just depends, they have been available codes for 4 years and slowly as they are used more and more payers pick them up as a payable service. There are a total of 6 codes for phone calls. Be sure to read the rules carefully and I encourge providers to use them.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default T-Cons
    Hi ngdave1

    Here is a sample of the DoD guidelines. The last paragraph gives the reasons for when the T-Cons are not applicable.
    Just to give you an idea...
    Good Luck


    3.5. Patient to Provider communication via telephone services and electronic media

    All patient-to-provider communication will be documented within the patient's medical record. For assessment, evaluation and management via electronic communications, such as emails, the patient's consent is required. The telephone (T-con) module may be used to document both telephone and e-mail communications. Each service may have explicit policies concerning electronic communications.

    Medical record documentation for telephone or electronic communication between patient and provider will follow medical record documentation standards.

    Documentation guidelines for e-mail communication between patient and provider include a physician's timely response to the patient's inquiry and must involve the permanent storage of this communication with either hard copy or electronic storage. It also encompasses the sum of communication including related telephone calls, prescription refills, or laboratory orders associated with the same on-line encounter.

    3.5.1. Privileged Provider
    For privileged providers [to include IDC's and residents beyond post-graduate year one (PGY1)] to use the following codes, communications via telephone or electronic media must be initiated by an established patient. Documentation must contain evidence of medical decision making by a licensed provider directly responsible for the management of the patient's care.

    99441 Telephone evaluation and management service provided by a privileged provider to an established patient, parent, or guardian not originating from a related E&M service provided within the previous 7 days nor leading to an E&M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    99442 ; 11-20 minutes of medical discussion
    99443 ; 21-30 minutes of medical discussion

    99444 Online evaluation and management provided by a privileged provider to an established patient, guardian, or health care provider not originating from a related E&M service provided within the previous 7 days, using the internet or similar electronic communications network.

    3.5.2. Non Privileged Provider
    For nurses and technicians (including IDMTs) to use the following codes, communications via telephone or electronic media must be initiated by an established patient.

    98966 Telephone assessment and management service provided by a non privileged provider to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment
    and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
    98967 ; 11-20 minutes of medical discussion
    98968 ; 21-30 minutes of medical discussion

    98969 Online assessment and management provided by a non privileged provider to an established patient, guardian, or health care provider not originating from a related assessment and management services provided within the previous 7 days, using the internet or similar electronic communications network.

    Patient initiated situations applicable for telephone and on-line communications

    Examples include the following:
    • A patient describes new symptoms and requests intervention or advice from the privileged provider.
    • In response to a patient communication, a privileged provider makes a new diagnosis and prescribes new treatment.
    • A patient describes ongoing symptoms from a recent acute problem or chronic health problem and requests intervention or advice from the privileged provider to treat ongoing acute problem or chronic health problem.
    • In response to a patient communication, a privileged provider gives substantive medical advice, revises a treatment plan, prescribes or revises medication, recommending additional testing, or provides self care or patient education information for new or chronic health problem.
    • A patient requests interpretation of lab or test results with evidence that the privileged provider is giving substantive explanation and possibly making recommendations to modify treatment plan, revise medications, etc.
    • In response to a patient communication, a privileged provider gives extended personal patient counseling that changes the course of treatment and affects the potential health outcome.


    DoD Rule

    There may be patient initiated communications that do not meet the criteria above and should be coded with a 99499.

    Administrative telephone calls, or encounters/episode of care that would have not previously been captured or coded in MHS will now be captured as non-count and coded with 99499 in the E&M field and appropriate administrative V Code as a diagnosis.

    3.6. Provider (privileged and non privileged) Initiated Telephone Calls
    99499 is to be used for provider initiated telephone calls. Use 99499 as the E&M in the T-CON* module, and the diagnosis as the reason for the call.

    The following list gives examples where you will not apply telephone and electronic communications codes (applies to privileged and non privileged providers):

    • Telephone services referring to an E&M service performed and reported by the same provider occurring within the past 7 days
    • Telephone services ending with a decision to see the patient within 24 hours or next available urgent visit appointment
    • Telephone services occurring within the post operative period of the previously completed procedure
    • New patient interaction
    • Provider to provider interaction
    • Provider to commander interaction
    • Leaving messages on answering machines
    • Scheduling/Billing/Administrative issues
    • Communication of non-clinical information
    • Telephone services completed by residents that are PGY-1's
    • Providing test results without any medical decision making
    The Oracle

  4. Default
    Thank you for your responses. I am specifically interested in knowing if Medicare would pay for these services. The Codes 99441-43 and 98966-68 are not in Medicare Fee Schedule for our state. Is there any HCPCs code to use with Medicare?

    Thank you

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