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Thread: Billing an E/M code.

  1. #1

    Default Billing an E/M code.

    AAPC: Back to School
    Good Morning,

    I work for a small practice and we have a provider who is confused as to how she would code a senerio where she spoke with a patient over the phone to let her know the hospital called her to discuss her blood results. The doctor stated she did the assesment and plan over the phone while talking to the patient and informed her she needed to go get a transfusion at the hospital. The patient didn't want to be admitted for observation care so she informed the doctor that she could send her as an outpatient. The doctor didn't go see the patient in the hospital but did stay up to date with the patients' status until she was discharged. Since the patient wasn't seen in the office or in the hospital would the doctor bill an E/M code since it includes outpatient settings or a telephone encounter code? We were not sure if outpatient settings meant that the physician saw the patient in the office? If anyone could try to help that would be great!


  2. #2
    Join Date
    Apr 2007
    Lexington Kentucky Chapter


    You might want to look at 99441 - 99444, which is geared toward just such a scenario.

    David Keown, CPC, OCS

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    You cannot use 99441-99444 as these must be initiated by the patient and this call was not. You will need to look at 99358 but time must be documented and it must be a minimum of 30 minutes to use this code.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4

    Default Billing an E/M code.

    Hi David,

    Thank you for your response, it did lead us to the right direction.

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default No codeable service

    I agree with Debra that you cannot use 9944x as these codes must be initiated by the patient ... AND ... cannot be within 7 days of a billable E/M.

    I do not think you can use 99358 either, as I interpret "before or after" to mean directly preceding or following an E/M service, and there was none on this DOS (if I'm interpreting your original post correctly).

    Sorry, this is nonbillable, though admirable medical care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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