Simply put, if a conversation with a patient results in a visit to your office within the next 24 hours, or next available appointment if they cannot get a appointment within the next 24 hours, then the time on the phone just becomes part of that office visit.  Also, if the phone conversation between you and the patient refers to an E/M visit in the previous seven days, then that phone conversation is considered part of that treatment.

 The CPT codes for telephone conversations are:

•  99441 for 5-10 minutes
•  99442 for 11-20 minutes
•  99443 for 21-30 minutes

 Examples of conversations for which you can bill are:

• Reviewing or changing a dietary regimen (though your registered nutritionist should handle these responsibilities)
• Reviewing or changing an exercise/rehabilitation program (though your physical therapist should handle these responsibilities
• Pre and post operative consultations (as long as they comply with the guidelines outlined above)

There are also CPT codes for physician-to-physician discussions concerning the management of the patient’s case.  The CPT code is 99358 for 30-60 minutes of non direct face-to-face communication by a physician when they are spending time on a specific patient’s case, and 99359 for each additional 30 minutes.  Sorry, there is no CPT code for less than 30 minutes of time spent; however, the time spent does not have to be continuous, just documentable.  The code 99358 covers time spent reviewing test results, reviewing extensive medical records, and communication with another physician.

The use of these codes may become tricky as Medical Homes and Accountable Care Organizations become more prevalent.  In both of these cases, the concept is supposed to reduce costs by establishing a provider community which will oversee the patient’s entire healthcare needs at a flat rate, or at least a reduced cost.  The Patient Protection and Affordable Care Act (PPACA) relies on these types of healthcare provider groups to control the amount of unnecessary duplication of services and unnecessary treatment.  These CPT codes may be deleted from future manuals, which will further decrease the private practitioner or small group practice’s income.

You also need to keep in mind that although the time spent by a healthcare provider on non-face-to-face management of a patient’s case may be billable, healthcare insurance policies may not cover these codes.  This is especially true within the Medical Home or ACO concept, where there is a contractual agreement between the providers and the carrier.

In a traditional fee-for-service healthcare policy, you are much more likely to get reimbursed for your time spent managing a patient’s case, though not every insurance carrier will cover this time.  Your office should find out early on in the patient’s case if their insurance covers non-face-to-face time spent managing the patient’s case.  This may affect how you manage the case to maximize the effectiveness for the patient, while allowing you to receive fair compensation for your time.

 Of course, you can always bill the patient for the time to manage their care, but this is a tricky situation that you might want to avoid.  You don’t want to get a reputation (like some lawyers) as someone who bills for every minute spent talking to clients, because then a patient may not make a phone call with a serious question that may greatly affect their health.  So use discretion if you bill a patient directly for phone calls or e-mails.