Take Care When Billing…

Many of our doctors have received an email from a practice management company which discusses billing for certain services such as Telephone Services, Smoking, and Tobacco Use Cessation Counseling, Prolonged Services and Critical Care. Although these services are billable, it is important to realize additional information that should have been included in the information you received.

Telephone Services

Although telephone services can be billed, they can only be billed in certain circumstances. The key piece of information that was not included in the email you may have received from a practice management group is that the telephone service MUST be initiated by an established patient or guardian of an established patient.

Advertisement

Smoking and Tobacco Use Cessation Counseling

Please remember, these codes must be used with a face to face service that is distinct from E/M services and time spent providing these services may not be used as basis for E/M selection. Behavior change services involve specific validated interventions of assessing readiness for change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling and arranging for services and follow-up.

Prolonged Services

There are additional caveats which were not included in the email you may have received. These codes must be listed separately in addition to office or other E/M services. In the CPT® code book they use examples like Maternal-fetal monitoring for high-risk delivery or other physiological monitoring or prolong care and treatment of an acute asthmatic patient. The use of these codes may very well raise red flags if used by D.C.s unless there are some very unusual circumstances.

Critical Care

The Critical Care codes included in the email have approximately two-pages of information in the CPT® code book. In fact, the CPT® code book states that critical care is the direct delivery by a physician of medical care for critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.

When receiving information remember to always exercise judgment and research the information to insure you continue to bill appropriately for the services you perform. Check your CPT® Guidelines book to make sure you meet all of the qualifications for billing the code. If you have any questions, please email insurance@ilchiro.org/.

“CPT Copyright 2017 American Medical Association. All rights reserved.
CPT® is a registered trademark of the American Medical Association.”