Author Topic: Telephone Therapy  (Read 2931 times)

Angie

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Telephone Therapy
« on: March 27, 2013, 11:56:30 AM »
Would it be appropriate to use the 98966-98968 Non face to face Nonphysician codes for telephone therapy that is being provided by a LCSW?

Here is the other thing: The therapist is licensed in the state of UT and the patient is in the facility in the state of UT when they do family phone therapy they are calling to another state where the family lives; CA. Does that effect if you can bill those because the therapist is not licensed in the state they are calling the family in; CA; even though it is for the patient that is in state that the therapist is licensed in? ???  ???

One of our patients told us that their insurance told them we need to use 90847 with a GT modifier; but the 90847 is a face to face and the telephone call is not face to face with the parents of the patient......even thought the patient is on the phone with the therapist and the family they are not face to face with the family as they are in another state.......

PMRNC

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Re: Telephone Therapy
« Reply #1 on: March 27, 2013, 01:18:00 PM »

Its probably easier to give you the coding guidelines for these codes because the info you have really isn't enough to say you could use the codes or not.  ONE thing I will say as I always say. NEVER let an insurance carrier tell you how to code, that is ultimately your responsibility and coding is done using the medical record. Patients will sometimes tell you their insurance company tells them how they want their bills.. 90% of the time they are fabricating or misunderstanding. Insurance companies are trained extensively NOT to give coding advice, what most likely happened was the patient asked what was covered.. if the insurance company pays for those telephone calls I will be surprised, but we know they will reimburse the 90847  ;) ;) ;)



CPT Codes for Phone Call and Online Patient Care

CPT Codes for Telephone Care

CPT codes: 99441-99444 and 98966-98969 are effective as of January 1, 2009, relating to billing for Patient Phone calls and internet online medical care.

There are six (6)  time-based codes for reporting telephone care. These new codes are intended for use in situations where an established patient is seeking advice or treatment for a problem that does not require a face-to-face visit.

There are two (2) online service codes for reporting patient care provided in an online method.

These telephone codes are time-based codes, so time spent must be documented. Both telephone care and online care require documenting the nature of the service and pertinent details for the medical record.

Medicare has assigned RVUs and pricing for these new codes. At this time Medicare has designated these codes as Non-Covered services. This means that physicians are free to bill–and be paid for–the services described by these codes. Commercial plans will develop their own coverage policies; many will follow Medicare’s lead.

Following are the descriptors for these new Non-Face-to-Face Services.  Please note there are separate sets of codes for use by physicians and non-physician practitioners. Physicians will report codes from the Evaluation and Management chapter of CPT; non-physician practitioners will report codes from the Medicine chapter.

Telephone Services–Physician

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;

99441  effective date: 1/1/2009  Phone E&M by Physician 5 to 10 minutes of medical discussion

99442  effective date: 1/1/2009  Phone E&M by Physician 11 to 20 minutes of medical discussion

99443  effective date: 1/1/2009  Phone E&M by Physician 21 to 31 minutes of medical discussion

Online Services – Physician

99444  effective date: 1/1/2009  Online E&M by Physician of medical discussion


Telephone Services–Non-Physician Healthcare Provider


Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment;

98966  effective date: 1/1/2009  Healthcare Provider phone call 5 to 10 minutes of medical discussion

98967  effective date: 1/1/2009  Healthcare Provider phone call 11 to 20 minutes of medical discussion

98968  effective date: 1/1/2009  Healthcare Provider phone call 21 to 30 minutes of medical discussion

Online Services – Non-Physician Healthcare Provider

98969  effective date: 1/1/2009  Online service by Healthcare Provider

Coding Guidelines

    These codes may be reported only for established patients, not new patients.
    The patient or patient’s parent/guardian must initiate the contact. These codes may not be used for calls initiated by a provider.
    Calls resulting in a face-to-face encounter for the same problem within 24 hours are not reportable.


If the call relates to and occurs within 7 days of another E/M service performed and reported by the same provider for the same problem, the call is not reportable. This also means that a telephone call related to a previous call within 7 days is not reportable, since these codes are themselves an E/M service.
Calls related to and takes place within the postoperative period of a procedure performed by the same physician are not reportable and considered to be part of the global surgical package.


    Telephone calls should not be reported for care plan oversight or anticoagulation management when the same communication is reported using codes 99339-99340, 99374-99380, or 99363-99364.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Angie

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Re: Telephone Therapy
« Reply #2 on: March 27, 2013, 03:36:11 PM »
Thanks Linda!!!!
The 90847 or 90846 should NOT be used though correct for a telephone session........
So none of these apply then if I am reading it correctly. They are not E/M services they are strictly family telephone sessions and they are initiated by the provider to discuss treatment. 
Also they have an 90837 Ind session on Tues and Family on Thurs so they are within the 7 days correct even though they are not the same codes????

Example of Family Call Note:

Date: 08/30/2012
Duration: 60 minutes

Participants:
Smith, David Psy.D., John Doe (Patients Parent)
Discussion Areas:
Provided summary of patients week and processed family reactions.
Processed family dynamics and relation to patients treatment.
Discussed upcoming assignments for patient and family members.
Discussed family communication with patient related to letters.
Discussed aftercare planning for Patient.

PMRNC

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Re: Telephone Therapy
« Reply #3 on: March 27, 2013, 06:31:56 PM »
Quote
The 90847 or 90846 should NOT be used though correct for a telephone session........

Absolutely NOT.. they are face to face codes.

Remember also that the telephone care codes have to be initiated by the provider. I'm still not fully comfortable telling you to go ahead and bill which is why I put the guidelines.. so with that said, if it was ME coding.. I'd not code it UNLESS I was confident that the medical record reflected the codes as per the guidelines I posted.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com