TMA Knowledge Center staff fields hundreds of questions about coding and billing from TMA members, on the phone, via email, and online through the Ask TMA FAQs. Here are a few from the FAQs. Do you know the answers to these questions? (Answers are below.)
- We have a clinic that stays open 24 hours. Can we bill and receive payment for 99050 codes for patients who come after routine office hours? Our other clinics are open 8 am-5 pm.
- What are the CPT codes to use when coding for a sports, camp, or school physical?
- If a patient comes in to the office for a new problem, can we bill for an initial office evaluation?
- Do operative reports on surgeries a physician performed at a hospital have to be on site at the physician’s practice business office for the charges to be submitted?
- May I deny access to a patient’s medical record because of a past due account?
- Can a physician bill a telephone call during the day and/or after hours to Medicare, and if so, what is the CPT code?
- Under what circumstances may a physician’s services be billed under the name of another physician? Locum? Employee physician?
- If the clinic is open 24 hours, then the 99050 codes would not apply, as the clinic is not staying open past its office hours. The code is not defined as after “standard” office hours or with any time frame.
- There are no specific CPT codes for sports physicals; bill them using the preventive medicine codes 99391-99397 when you include a comprehensive patient history and exam. Generally, insurance carriers will not pay for sports or camp physicals.
- No. An “initial office evaluation” is for new patients, not new problems. CPT defines a new patient as one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.
- Generally, no, they do not have to be stored in the physician’s office; however they must be in a place where the physician has access to the documentation at any time needed. Refer to your insurance contracts regarding any specific rules relating to billing requirements. Also, check with your liability insurance carrier for any requirements it might have.
- No. Texas Medical Board rules say medical records may not be withheld from the patient, the patient’s authorized representative, or the patient’s designated recipient for such records based on a past due account for medical care or treatment previously rendered to the patient.
- No. Medicare considers these codes (99371-99372) as “bundled” services. You may not bill Medicare or the patient for a telephone call. (Note: This FAQ is not related to telephone calls that may be considered part of Medicare's Chronic Care Management Services program.)
- The only time billing under another physician’s name is appropriate is under a locum tenens arrangement. Employee physicians must bill under their own name. It is not appropriate to bill using an established physician’s provider number while a new physician is being credentialed with a health plan. Medicare does not prohibit a physician from billing incident to under another physician’s name; however, you must follow all incident-to guidelines, and you should not consider this a substitution for enrolling the physician in Medicare.
If are a TMA member and you have a coding or billing question, call the TMA Knowledge Center at (800) 880-7955, and ask to speak to a reimbursement specialist, or email knowledge[at]texmed[dot]org. Or, if you are looking for more in-depth help, consider calling on TMA Practice Consulting for one of its coding and documentation services.
Read all the FAQs online . For answers to many of the most commonly asked questions, see You’ve Got Questions? We Have Answers , available in the TMA Education Center.
Published Nov. 12, 2015
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Last Updated On
December 09, 2016