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Medical Coding News Archives

AMA Adds Codes for Telephone Services

 
October 30, 2007:
Beware—coders must be careful using the new CPT® codes for telephone services because they are assigned depending on provider type. The American Medical Association included the new codes as part of its update for 2008.

Physician Services
CPT® codes 99441–99443 are used to report telephone evaluation and management services that are provided by a physician to an established patient or the guardian of the established patient and must be initiated by the patient. One of these codes is reported only if there is no decision to see the patient within 24 hours or the next available urgent appointment, or if the code does not refer to an E/M service performed and reported by the physician within seven days or within the postoperative period of the previously completed procedure.

99441 Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes
99442          11–20 minutes of medical discussion
99443          21–30 minutes of medical discussion


Appropriate code selection depends on the time spent in discussion with the patient. Time documenting the discussion is excluded. Do not report codes 99441–99443 in conjunction with care plan oversight services (codes 99374–99380 and 99374–99380) for the same calls.

Nonphysician Services
When a qualified health care professional (nonphysician) provides telephone assessment and management services to a patient in a non-face-to-face encounter, report 98966–98968. Like the physician services, these episodes of care must be initiated by an established patient or by the patient`s guardian, are not reported if the telephone service results in a decision to see the patient within 24 hours or at the next available urgent visit appointment; and are not reported if the telephone call is in reference to a service performed and reported by the qualified health care professional that occurred within the past seven days or within the postoperative period of a previously completed procedure. This applies both to unsolicited patient follow-up or that requested by the health care professional. Report 98966 for telephone services requiring five to 10 minutes of medical discussion, 98967 for telephone services requiring 11 to 20 minutes of medical discussion, and 98968 for telephone services requiring 21 to 30 minutes of medical discussion. Do not report 98966–98968 if these codes have been reported within the previous seven days.

Online Medical Evaluation
The AMA also added codes for online evaluation and management services. Code selection for this service also depends on the type of provider. Code 99444 should be used when a physician provides the service; code 98966 when provided by a nonphysician provider.

99444          Online evaluation and management service provided by physician to an established patient, guardian, or health care provider not originating from a related E/M service provided within the previous 7 days, using the internet or similar electronic communications network

With the exception of provider type, the guidelines are the same for both codes. Online assessment and management service must be provided to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous seven days, using the internet or similar electronic communications network. This code is reported only once during the seven-day period for the same episode.

Deborah C. Hall
Clinical/Technical Editor

CPT is a registered trademark of the American Medical Association.

 

 
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