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Phone Code Update
Mar
6
A surreal moment - I am in Richmond, VA listening to Dr.Lander talk about coding during the Pediatric Alliance/VAAAP event while working on the blog. And watching my laptopbattery drain quickly!
About a year ago, we did a quick run-down on the "non face-to-face"codes, more commonly known as "billing for phone calls." It was both encouraging and sad at the same time. Time foran update.
Things are still sad - it's a small minority of PCC clients using thecodes (5%?). However, the news is not all bad.
We have insurance payments, now, in 13 states - CA, MA, NJ, MD, PA,VT, MI, GA, OH, NY, IL, WA, and KY.
We have some major growth in the non-physician phone codeusage (98966-98968).
Below, I've split the results into two categories - how much was charged/paid when the code is paid and how much is charged/paid overall. Note that there isn't a whole lot use of these codes when it's not being paid.
| Code | Average Charge | Average Payment |
| 99441 ($ > 0) | $18.80 | $6.69 |
| 99442 ($ > 0) | $37.33 | $17.28 |
| 99443 ($ > 0) | $55.03 | $25.46 |
| 98966 ($ > 0) | $14.72 | $6.95 |
| 98967 ($ > 0) | $33.75 | $7.91 |
| 98968 ($ > 0) | $35.00 | $35.00 |
| 99441 (overall) | $18.81 | $5.34 |
| 99442 (overall) | $37.26 | $13.85 |
| 98966 (overall) | $15.00 | $6.79 |
| 98967 (overall) | $32.73 | $3.29 |
| 98968 (overall) | $49.00 | $3.50 |
Interesting, certainly, no?
Back to the meeting!
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- 8 comments
Phone codes
So mostly only those who are getting paid are using the phone codes? You'll never know if you might get paid if you don't use them, however.
Jesse Hackell MD
Phone codes
I think that's the crux of it - though there is an increase in personal payments on the codes this year. In other words, more practices are getting their patients to pay when the inscos don't.
Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog
Phone codes
when it goes to the family's deductible and the patient pays we found that it is best that we have informed them ahead of time what the price will be
the doctor on call will say, "it may be possible to handle your child's illness via the phone instead of sending you to the ER, Now that we have computerized records I can evaluate your child's sx with the chart in front of me, There is a $15 charge for this but I bet it is a lot cheaper then the ER!
We have decided to look at it for 6 months and then adjust
I just saw Aetna's new April 1 "rest of PA" fee schedule and the base payment for
phone E/Ms are
99441 $14.00
99442 $25.00
99443 $37.00
and online e/m 99444 $30.00
Lynn Cramer
Phone codes
...and, meanwhile, the payer saves a bundle.
Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog
Phone codes
I have tried & mine are not getting paid. I'm I doing something wrong?
I billed a pt with a: 99358 with a 98968
This was denied!!! We also didit with a modifier on 99358-25 DENIED,
I also did 99358 by it self DENIED. What is the correct way to code it???
Thanks
Denise
Galloway Pediatrics, NJ
Phone codes
First, I'm not surprised, Denise, that you didn't get paid. Most payers still aren't paying these codes. Which payers rejected them? Were you expecting payment?
The only thing you can do is pick up the phone and ask them how they want you to bill these codes. And share with us the answer they gave you.
For some guidelines about billing this properly, here you really want the AAP's "Payment For Telephone Care: A Toolkit".
Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog
Phone codes
Well according to your notes NJ is part of the states they paid, I have sent it to BCBS, Aetna, Cigna & all have denied. So do not know what to do.
Thanks
Denise
Phone codes
Pick up the phone, call your reps! They need to tell you what's up!
Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog