“We have had an influx of phone calls that are burdening our clinical hours. We have been flooded with questions that pertain to patient care, clarification of orders and home care instructions. Is there a way to bill for these calls? Each call can take 20-45 minutes for our medical assistants to complete. And we are trying to manage a full clinic at the same time.”
When talking about Telehealth Billing, specifically through the use of a telephone, the type of Virtual Service that is the most appropriate is Telephone E/M Services. The key points of this Virtual Service are the following:
*Services are non-face-to-face E/M services provided to a patient using the telephone by a physician.
*Used to report episodes of patient care initiated by an established patient or guardian of an established patient.
*The patient must initiate the initial inquiry, and communications can occur over a 7 day period.
However, the provider can educate the patient regarding this option.
*Encounters are billed as E/M services, the documentation requirements for E/M services are in effect.
*Must have history, as much of an evaluation as possible and some form of medical management
*This service is not reimbursed by all payers. You need to confirm prior to performing the service.
*If the telephone service ends with a decision to see the patient within 24 hours or the next available urgent visit appointment, the code is not reported.
*If the telephone call refers to an E/M service performed and reported by that individual within the previous 7 days, either requested or as an unsolicited patient follow-up, or within the postoperative period of the previously completed procedure, then the service(s) is considered to be part of the previous E/M service or procedure.
What about the codes?
CPT 99441 Telephone evaluation and management service by a physician provided 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 of medical discussion
CPT 99442 11-20 minutes of medical discussion
CPT 99443 21-30 minutes of medical discussion
When you look at the scenario in the above post and you apply it to the key points and the codes that are billed when performing Telephone E/M Services, with the exception of the fact that it appears that the telephone calls were initiated by the patient, none of the other defining criteria appear to be met. Most important of all is the fact that the encounters are being addressed and handled by the medical assistants when clearly the service needs to be provided by the physician. It also appears that the telephone calls are related to prior encounters, E/M services that were provided within the previous 7 days or were related to a procedure that has set a postoperative global period.
Unfortunately, the telephone calls that have been coming into the office, despite the fact that they are time consuming and “burdening the clinical hours” are not billable and not reimbursable.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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