Q: What are some overlooked codes that are available to use for services physicians are already providing regularly that may be overlooked?
A:Physicians and practice administrators are always looking for how to maximize profits. As a coding/billing consultant, chart auditor, and educator, I’m often asked about ways to improve coding. Here are three codes that I find are often misunderstood, underused, or unknown.
Practices that know about these codes—and how to use them—may be able to earn additional reimbursement.
Telephone services (99441-99443)
Doctors’ offices are busy places, and it isn’t unusual for patients to call in asking to speak with the doctor. CPT offers codes to report telephone services provided by a physician or other qualified health care professional who may report evaluation and management (E/M) services. These codes can only be reported for an established patient and are not billable if the call results in the patient coming in for a face-to-face service within the next 24 hours (or next available urgent visit). These calls are also not billable if they refer to an E/M service performed within the last seven days. The codes are selected from code range 99441 to 99443 and are based on the time spent: 5-10 minutes, 11-20 minutes, or 21-30 minutes, respectively.
99058: Services provided on an emergency basis
What can you do when your providers already have a packed schedule and a patient walks in demanding to be seen? What if a scheduled nurse visit is more serious than anticipated, and the provider is called to step in and spend a great deal of time with that patient? When a patient is seen on an emergency basis in the office—and it disrupts other scheduled office services—you may be able to report add-on code 99058 for additional reimbursement.
96160: Health risk assessment
Providers can bill code 96160 when they perform a health risk assessment with a patient or caregiver/guardian in order to assess the risk of conditions such as mental disorders. They can also report 96160 when administering a patient-focused health risk assessment. Providers should report 96161 for a caregiver-focused health risk assessment, such as depression inventory, for the benefit of the patient.
Telephone service CPT code descriptions