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Phone call with work comp case manager

K Posted Wed 08th of April, 2015 12:31:04 PM

Hello, our provider would like to bill for a telephone call with a work comp case manager. If they have a conversation, it is usually less than 1/2 hour. It is only the work comp case manager and the MD or PA involved in the call. Sometime the MD, PA and case manager will have a conversation.

Sometimes they try to call the case manager and leave a message and they want to bill for this time.

Can we bill for this, if so what codes would we use?

It seems like most of the telephone calls are to patient and or family, not a case manager. The team conference has the providers face to face, and I do not fee they would be correct codes to use.

Could a unlisted code work? 99499 This may not have a allowed amount, may be by report only, but it would document the time they do spend on case manager calls....

What do you think is the correct coding for this?

SuperCoder Answered Thu 09th of April, 2015 05:56:37 AM

I think this service is not payable since there is no conversation between the provider and work comp case manager (only a voice mail left for the case manager).
However, in the rarest of circumstances, when your physician (or NPP) provides a service that does not reflect a CPT® code description, you must report the service as an unlisted service with 99499 (Unlisted evaluation and management service). A description of the service provided in the form of the provider’s notes must accompany the claim. The payer has the discretion to value the service when it does not meet the full terms of a CPT® code description. You need to get in touch with your payer to verify if they pay such services.

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