Reimbursement for telephone care.

Abstract

In today’s health care environment, telephone care is an increasing component of pediatric practice.1,2 Under pressure to limit office and emergency department utilization and with increasing expectations for access by working parents, pediatricians are finding themselves dispensing more and more advice over the telephone, both during and after office hours. Practice surveys have reported that telephone care accounts for at least 20% of all clinical care in a general pediatric practice and as much as 80% of after-hours pediatric care.3–5 Telephone care is not only an issue in primary care. Many pediatric subspecialists who care for children with chronic and special needs, such as diabetes or seizures, face extraordinary burdens in providing telephone-based disease management.6 For others, such as pediatric infectious disease specialists, telephone consultation represents a significant part of their practice, and the issue of reimbursement for telephone care is of paramount importance. The American Medical Association’s Current Procedural Terminology (CPT-4) manual, the standard reference for coding medical encounters with patients, categorizes telephone calls as case management services.7 Telephone calls by physicians for case management (eg, consultation, medical management, coordination of care) are categorized by complexity of medical decision making. Case management telephone calls involving simple, intermediate, or complex decision making are described by CPT codes 99371, 99372, and 99373, respectively (Table 1). If these calls lead to a visit, then they may be included in the preservice component of evaluation and management (E&M) codes. View this table: TABLE 1. CPT Codes and RVUs for Telephone Calls Telephone calls are also included within “Care Plan Oversight Services,” which reflect physician work in the complex and multidisciplinary management of patients being cared for by a home health agency, hospice, or nursing facility, and can be reported using CPT codes 99374, 99375, and 99377 to 99380.7 … Reprint requests to (S.M.M.) Children’s Hospital and Regional Medical Center and the University of Washington School of Medicine, 4800 Sand Point Way NE, Box 5371 (MS: CH-41), Seattle, WA 98105-0371. E-mail: smelze{at}chmc.org