Newly Revised Payment for Telephone Care: A Toolkit

As you are aware, the codes used to report physician telephone evaluation and management (E/M) services (99441– 99443) were revised in Current Procedural Terminology (CPT®) 2008, and new codes were added to report telephone E/M services provided by a qualified nonphysician health care professional (98966–98968). For a comprehensive summary of reporting guidelines for physician telephone E/M services, refer to the December 2007 AAP Pediatric Coding Newsletter™ (Vol 3, No. 3) article, "New 2008 CPT Case Management Services Codes." It is important to note that the Centers for Medicare & Medicaid Services published relative value units (RVUs) for codes 99441–99443 in the 2008 Medicare Resource-Based Relative Value Scale. This is excellent news because Medicaid programs and commercial payers may start to recognize the services. The total non-facility (eg, office, home) 2008 Medicare RVUs are

Because telephone E/M services can only be reported under very specific guidelines (ie, physician management of a new problem that does not result in an office visit within 24 hours from the telephone call or at the next available urgent visit appointment; physician management of an existing problem for which the patient was not seen in a face-toface encounter in the previous 7 days from the telephone call [physician requested or unsolicited patient follow-up] or within the postoperative period of a performed and reported procedure), it is critical that each practice develop a policy for capturing and reporting them.

The Section on Telephone Care Executive Committee has revised Payment for Telephone Care: A Toolkit to incorporate the 2008 CPT codes and their guidelines. The information included is essential because it assists physicians with documentation and has tips on how to notify payers and patients and how to capture the time and effort spent in telephone management. In addition, useful tools have been developed and are included for use by practices.

As you will note from the table of contents, this toolkit is extremely comprehensive and valuable to any physician practice that reports or wishes to report telephone E/M services.

Chapter

1. What Is Telephone Care?

2. Reviewing the AAP Policy Statement

3. Evaluating Payer Contracts

4. Choosing the Types of Calls

5. Notifying Patients

6. Notifying Payers

7. Documenting Telephone Care

8. Coding Telephone Care

9. Billing and Collections for Telephone Care

10. Managing Medical Liability Risks for Telephone Care

11. Implementing and Evaluating Telephone Care

Tools

A. Advance Beneficiary Notices

B. New Payer Contracts—Contract Addendum

C. Choices of Billable Telephone Care

D. Sample Patient Notification Letter Version 1

E. Sample Patient Notification Letter Version 2

F. Sample Patient Notification Letter Version 3

G. Sample Office Sign

H. Sample Office Answering Message

I. Sample Staff Scripts

J. Sample Payer Notification Letter

K. Sample Telephone Documentation Form Version 1

L. Sample Telephone Documentation Form Version 2

M. Sample Care Plan Oversight Documentation Version 1

N. Sample Care Plan Oversight Documentation Version 2

O. Scenarios to Facilitate Consistent Charging

P. Sample Appeal Letter to Payer

Q. Suggested Timeline

R. Making the Case for Telephone Care

S. Resources from the AAP

The toolkit is only available online to members of the AAP. To access the kit, go to http://practice.aap.org/specialfeatures/telecarepmt.aspx. It is recommended that every practice obtain a copy of this toolkit and share it with all physicians and administrative staff.

Note that the Section on Telephone Care is currently developing tools for use by physicians who provide online E/M services (CPT code 99444).