Should Your Practice Be Billing Codes For Telephone Consultations?

It seems these days as if practices are doing more and more patient consultations over the phone. A lot of this may be due to the current economic conditions and the fact that patients are trying to avoid having to come in and be seen and be charged a co-pay.

What ever the reason physicians are spending more time on the phone these days and are asking whether or not they can bill CPT codes for telephone consultations and get reimbursed.

Unfortunately, Medicare will not pay for patient consultations performed over the phone. In terms of other payers, you will have to check with them on a case by case basis.

If this issue has become a big problem for your practice and is absorbing a lot of your time, you may want to consider billing your patients for this service.

Telephone services are typically billed using two sets of codes added to the CPT index in 2008: codes 99441 – 99443 are for phone services by physicians, while 98966 – 98968 are for services by “qualified non-physician healthcare professionals.” Again, none of these codes are covered by Medicare but more and more private payers are starting to reimburse for this code so it is certainly worth checking with them to see if they will pay.

If you do decide to bill patients for these codes, here are five things you must know about these codes:

  • They may be billed only for “medical discussion” that IS NOT related to an E&M service that was provided within the last seven days and DOES NOT lead to an in-office visit within the next 24 hours or earliest possible date.
  • The phone conversation must be documented by the provider that took the call.
  • Though Medicare does not pay for these codes, both sets of codes have relative value units (RVU’s) assigned to them that you can use to help determine what fee you will charge your patients for these codes.
  • The patient must initiate the call in order for you to bill the service.
  • The codes are valid for established patients ONLY, according to the CPT guidelines.
  • If your practice is performing a significant amount of phone consultations, that revenue can add up over the course of a year and make a difference in your practice’s earnings.
  • If you are considering billing for phone consultations, here are some tips that should help you get paid:
  • Negotiate with private payers – The key is to document every instance over the course of a year that you provided a telephone consultation. The amount of consultations could be significant and show your physicians and other providers provided the service 120 times over a year. When you renegotiate your managed care contract, you can show the provider relations department of that payer the documentation supporting your 120 phone consultations and explain to them this is what you did. You can then ask the provider relations for an allowance from the payer for these consultations. If one payer agrees to pay for the phone consultations, take an EOB showing payment and show that to another payer and ask them if they would be willing to match it.
  • Discourage patients from lengthy phone calls and ask them to come in for an office visit – Most of your patients aren’t going to like the idea of you billing them for phone calls in general, much less ones that only take five minutes. If it appears that a phone call is going to be a long one, go ahead and encourage the patient to come in for an office visit and explain to them that way your insurance will pay for it instead of you having to bill them for the lengthy phone consultation.
  • Get paid for a growing practice expense – The CPT codes for telephone E&M services were established for a reason. If the codes are in the CPT book, you have every right to code them and bill for them. The key is to decide at what point you will bill for the phone consultation (i.e. 15 minutes, etc.) and to see how your patients react as you don’t want to run patients off but they have to understand your time is valuable.

This is a billable service that is definitely worth your practice looking into. You’d be surprised at how many of your private payers may reimburse you for these codes. In addition, if patients know they have to pay for lengthy phone consultations, they may just decide to come in and have a face to face visit.

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