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Collect Top Dollar for 99443 When Performing Telehealth

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Collect Top Dollar for 99443 When Performing Telehealth

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99443

When your provider talks to patient on the phone, you may worry that your payer won’t reimburse you appropriately for the visit, even though it takes just as much medical decision-making as an in-person visit. The good news is that Medicare pays over $128 for non-facility telephone visits if you report and document 99443 correctly.

Check out a few key strategies that can help you collect for 99443 when your provider talks to a patient on the phone.

The Medical Discussion Must Take 21 to 30 Minutes

CPT code 99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services 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; 21-30 minutes of medical discussion) is a level three service.

As noted in the descriptor, the provider must spend 21 to 30 minutes during the medical discussion with the patient. Note that this isn’t the total time spent on the phone. It’s the time on “medical discussion,” and your provider must clearly document that in the record.

For instance, “Mrs. Smith and I talked on the phone about her worsening gout symptoms. She shared her symptoms, how they’re affecting her quality of life, and her limitations. I talked to her about dietary change recommendations and potential treatment options. We spent 25 minutes specifically discussing her gout symptoms and management.”

If your provider documents fewer than 21 minutes — then you should instead revert to billing 99441 or 99442.

It Can’t Be Related to an E/M Service

If your provider saw a patient for an E/M visit and then talked to the patient on the phone the following week about the same topic covered at the E/M, that phone call wouldn’t be separately billable with 99443.

Why? Because the descriptor specifically says the phone call is “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.” If the phone call is related to a recent or upcoming E/M visit, it’s typically included in payment for the actual related E/M service.

Not All Services Can Be Reported With 99443

Payers are very specific about which types of services can be reported using 99443. For instance, many insurers don’t reimburse this code for mental health services, because the telephone isn’t considered private enough for these sensitive conversations. Always check with your payer to determine what’s reimbursable with 99443 and what isn’t.

Telemedicine coding can be challenging, but it doesn’t have to be. Get the scoop with this FREE Telemedicine Coding eGuide, which was updated for 2024 so you know it has the most current tips. Download your free copy today!


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