Watch Out for 3 Telephone Service Coding Pitfalls
Posted on 11. Oct, 2009 by Editor in Hot Coding Topics
Caution: You may need to incorporate the call into an in-office E/M service.
If you’re reporting services your physician provides over the phone, but you’re not getting paid, the reason might be one of two things — you’re not following the coding rules surrounding the codes or your payer just isn’t paying for those services. Check out these top three denial reasons to ensure that you’re not leaving money on the table by misusing these codes.
1. Check With Each Payer on Reimbursement Policy
CPT offers six codes for you to use to report telephone services: 98966-98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional …) and 99441-99443 (Telephone evaluation and management service provided by a physician …). As evident in the code descriptors, you will choose the proper code to report based on the time a practitioner spends on the telephone with the patient.
Red flag: Just because you have codes to report your telemedicine services, does not mean you’ll get paid. While CMS assigns relative value units (RVUs) to 98966- 98968 and 99441-99443, Medicare does not pay for these codes, says Maggie M. Mac, CMM, CPC, CPC-E/M, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla. CPT added 99441-99443 in 2008, and in the Medicare fee schedule the status on these codes has always been “N” or “non-covered,” explains William H. Geraghty Jr., CPC-I, revenue manager for GWU Medical Faculty Associates in Washington, D.C. Some private payers may pay you on these codes, however, so check with each of your individual insurance companies.
Beware: If you choose to report these codes for telephone services, be prepared to deal with potential negative responses. Patients may not like seeing that you’re charging their insurance — or the patients themselves — for a phone call.
2. Save 99441-99443 for the...
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Pam
12. Oct, 2009
In the pediatric practice that I worked in previously, we used these codes for evening and weekend calls received from parents who suspected their child had strep and wanted a strep test done. The parents were told up front by the on-call physician of this charge. These type of inquiries require numerous calls on the part of the physician. The physician has to call the order to the lab, receive the result back, call the parent back, and if the strep is positive, call the Rx into the pharmacy.
Most parents were more than willing to pay $25 for a phone call as many have copays that high anyway. It also kept them from having to with the ER or urent care waiting room for a long time and prevented possible exposure to other things while there. Some carriers required us to write them off, but for those that allowed us to bill the patient, we had very good luck with parents paying the charge.