2008 Billing Opportunities

Telephone Evaluation and Management Services

CPT 2008 includes two series of codes to report non-face-to-face Evaluation and Management (E/M) services via telephone.  All of the codes come with very specific usage instructions and the correct code selection depends on who provides the telephone service. 

The telephone services should not be reported if:

1. The telephone E/M service ends with a decision to see the patient within 24 hours or at the next available urgent visit appointment.
2. The telephone E/M service is related to an E/M service performed and billed within the previous 7 days.
3. The telephone E/M service is within the postoperative period of a previously completed procedure.
4. A telephone E/M service has been performed in the previous 7 days.

 

Telephone evaluation and management services provided by a PHYSICIAN to an established patient or guardian   

            99441              5 – 10 minutes of medical discussion
            99442              11 – 20 minutes of medical discussion
            99443              21 – 30 minutes of medical discussion

The same call may not be reported as a Telephone E/M service and counted as Care Plan Oversight time.  The Telephone E/M service codes should not be used to report anticoagulation management.

Telephone evaluation and management services provided by a QUALIFIED HEALTHCARE PROFESSIONAL to an established patient or guardian

98966              5 – 10 minutes of medical discussion
98967              11 – 20 minutes of medical discussion
98968              21 – 30 minutes of medical discussion

On-Line Medical Evaluation

CPT 2008 defines the On-line Medical Evaluation as “a non-face-to-face Evaluation and Management (E/M) service using Internet resources in response to a patient’s on-line inquiry.  The response must be timely, permanently stored (electronic or hard copy) and includes all related telephone calls, prescription provision, laboratory orders, etc.”

The On-Line Medical Evaluation may be reported only once during a 7 day period for the same episode of care and should not be reported if:

1. The On-Line Medical Evaluation is related to an E/M service performed and billed within the previous 7 days.
2. The On-Line Medical Evaluation is within the postoperative period of a previously completed procedure.

99444              Online evaluation and management service provided by a PHYSICIAN to an established patient, guardian, or health care provider using the Internet or similar electronic communication network.

98969              Online evaluation and management service provided by a QUALIFIED HEALTHCARE PROFESSIONAL to an established patient, guardian, or health care provider using the Internet or similar electronic communication network.

The Online E/M service should not be reported in addition to Care Plan Oversight and anticoagulation management.

These non-face-to-face codes are not included in the 2008 Medicare Physician Fee Schedule.

Previous Practice tips:
Article 1
Article 2