We support and encourage you to provide care for new and established patients through any means (telephone, video or in person) from any location (home or office), and at any time, as long as the care is clinically appropriate, properly documented and follows appropriate procedures.

Evaluation and management services by telephone can be conducted by physicians and non-physician healthcare professionals (as categorized in DOWC Rule 16-2).

• Telephone calls can be used with established patients.
• To be billable, the audio call must be a minimum of 5 minutes.
• The medical record documentation must support the code.

Billing codes

Telephone services, including those listed in Appendix T and Telephone Services of CPT®, must be billed with a modifier 93. These codes are available for telephone E&M services provided by a physician or non-physician practitioner to an established patient, parent or guardian.

• 99441 5 – 10 minutes of medical discussion with a physician
• 99442 11 – 20 minutes of medical discussion with a physician
• 99443 21 – 30 minutes of medical discussion with a physician
• 98966 5 – 10 minutes of medical discussion with a non-physician practitioner
• 98967 11 – 20 minutes of medical discussion with a non-physician practitioner
• 98968 21 – 30 minutes of medical discussion with a non-physician practitioner

Documentation

The medical record documentation for phone call should specify:

• The amount of time and date of service
• The patient, family member or healthcare provider talked to and
• The specific recommendations, assessment and/or decisions made during the conversation

Telephone or online services may be billed even if performed within the one-day and seven-day timelines listed in CPT®.

Please note that triage calls for coronavirus screening before initial evaluations are not payable when conducted by schedulers, medical assistants or nurses. Screening calls are considered part of the exam visit.

If you have questions about billing or coding, please contact the Pinnacol’s provider medical billing auditors at 303.361.4940 or billingsuccess@pinnacol.com.