Are documenting/submitting phone consultations and/or secure message exchanges worth the time and effort needed to appropriately do so?
Many consultants may come up with ideas on how to enhance practice revenue without taking into consideration if the work required of the pediatric providers is worth the results, whereas a pediatric practice owner/administrator is more prone to have this awareness. The purpose of this article is to provide the pediatric practice owner/administrator with some evaluative criteria related to billing for phone consultations and/or secure message exchanges. Let’s look at each of these areas:
- Phone Consultations (CPT Codes 99441-99443) – A provider is able to record a phone consultation with a patient, document the encounter, select the appropriate ICD-10 & CPT codes, and submit to the payer for reimbursement. In the PediatricXpress system, there is a feature that allows one to easily document a phone consultation. To do this, either the staff or provider opens a patient’s chart, clicks on the ‘Request a Phone Consult’ icon, and selects the provider who will be completing the consultation. With ease, the provider can document the date and time of consultation, chief complaint, history of present illness, diagnosis, prognosis, etc. Additionally, they may select the allotted time spent consulting with the patient — 5-10 Minutes (99441), 11-20 Minutes (99442), 20+ Minutes (99443) — or “Do Not Bill,” which allows the consultation to remain documented in the system without having been billed to the payer.
- Secure Messaging via Patient Portal (CPT Codes 99421-99423). A provider is able to document secure messaging medical encounters via the PediatricXpress system, similar to how they would document an in-office visit. Something to take into consideration is that, in almost all cases, it is better for overall patient engagement and practice revenue to complete a telehealth visit with the appropriate E&M code (2-3x more revenue for the practice by means of telehealth).
For most practices, over 50% of engagement outside of the office leads to a visit within seven days. With that being said, these codes can only be utilized if the patient did not have a visit to the practice within seven days of engagement. Some further background on these codes –
The codes (99421-99423) are used for reporting communications via secure email, patient portal, or other fixed means. The guidelines for selection of the appropriate code include:
5-10 Minutes (99421), 11-20 Minutes (99422), 21+ Minutes (99423). When determining the total billable time, consider the overall time spent interacting with the patient, time spent reviewing patient questions/concerns, time spent reviewing records and/or associated data, time spent generating prescriptions and/or lab tests, as well as follow-up communications.
Whether to bill the insurance carrier or the patient is a choice that practices should put a great deal of thought into before making a change to their current approach. Below is some additional information related to the decision making around billing for phone consultations and/or secure message exchanges.
- Most patients should either be seen in the office, or via telehealth, to provide optimal care and appropriate compensation for the provider’s time.
- Most communications via phone or secure messaging with providers are a follow-up for a previous appointment or ultimately leads to a visit within seven days. A visit in the office or via telehealth will typically remove the ability for phone consultation/digital exchange reimbursement.
- Patients with deductibles will usually pay for this service if the respective payer sees said service as reimbursable.
- The time for documentation and code selection tends to be greater than the revenue received, and may add to provider burnout.
So, while there are appropriate CPT codes for phone consultations (99441-99443) and secure message exchanges (99421-99423), switching from an in-person/telehealth approach to that of documenting phone consults/digital exchanges may ultimately decrease practice and/or provider revenue while still increasing overall workload. We recommend that each practice conducts their own analysis based on their respective approach to determine whether or not they may come to a different conclusion than that of what has been established above.