It's not as high-tech as a computer, but the telephone is another patient-friendly way to connect patients with their physicians for some medical situations.

Jennifer Swindle, director of coding and compliance at PivotHealth LLC, says the Centers for Medicare & Medicaid Services and many private payers do not reimburse for telephone visits. But some payers do, and she encourages physicians to submit the codes.

"If we don't report them, no one will know the service is happening, and reimbursement policies will never change because nobody knows who is doing it," she says. "The only way they have of knowing those services occur is if we report them."

The vast majority of patient calls to a physician's office are not billable. Telephone calls to notify patients about imaging or laboratory results or any other communication related to a previous visit are not to be billed.

Three CPT codes reflect three different time increments:

  • Code 99441 for 5 to 10 minutes
  • Code 99442 to 11 to 20 minutes
  • Code 99443 for 21 to 30 minutes

The codes should only be used when:

  • The visit is generated by the patient (or patient's guardian) who has a chief complaint that is discussed during the visit.
  • There is no patient visit one week before the phone call, and the phone call does not result in an office visit.

"It must truly be a standalone evaluation-and-management service that all happens over the telephone," says Swindle.

Return to related article: Payment Challenges Around Electronic Visits

Publication Date: Monday, September 27, 2010