Coding for Telephone Consultations

Q. What is the CPT code for telephone consultations? Does Medicare or any other major carrier cover this service?


A.  The 2008 Current Procedural Terminology (CPT) codes for telephone call consultations are 99441-99433 (replacing deleted codes 99371-99373). Times included in the new code descriptors will help coders select the correct level of service:

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

Medicare does not reimburse for this series of codes, nor do most commercial carriers. The Centers for Medicare & Medicaid Services has listed relative value units (RVUs) for these codes in the 2008 Medicare Physician Fee Schedule. Private payers potentially could use the RVUs in valuing and reimbursing for telephone services. You can review current policies of your major carriers on their Web sites to find out if they reimburse for telephone consultations.

Some extra clarification about the telephone consultation codes:

  • You cannot use them to report non-face-to-face communication between a physician and other health care professionals.
  • If the telephone service ends with a decision to see the patient within 24 hours or next available urgent visit appointment, do not report the code; the encounter is considered part of the preservice work of the subsequent E&M, procedure, and visit.
  • If the telephone call refers to an E&M service performed and reported by the physician within the previous seven days or within the postoperative period of the previously completed procedure, then the service(s) are considered part of that previous E&M service or procedure.
  • For telephone services provided by a qualified nonphysician health care professional, use CPT codes 98966-98968.

 

 

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