99441 CPT code

99441 CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Example

99441 CPT code is coding for evaluating and managing the services provided by a physician or any other qualified healthcare professional (QHP) related to an E/M service not given within the last seven days.

99441 CPT Code Description

Procedures not performed in the next 24 hours are also a part of 99441 CPT code. Medical discussion is for about 5-10 minutes performed in such kinds of calls through CPT code 99441 is attempted by the patient suffering from illness. The guardian of the patient can also make a call.

The coronavirus pandemic has launched some new and advanced ways in the medical field. Telehealth and telemedicine are a part of this advanced launch in the health field. Different kinds of coding are available for visiting patients.

The telehealth system monitors these patients. The telemedicine topic will increase with great acceptance in the coming years. Telecommunication and coding systems will provide these services through consulting on call. Different codes are designed to provide the consultation of allergists, immunologists, and others.

Telemedicine and its related area are evolving daily, and more services will be available to ensure the ongoing need for the providers.

E/M codes are known for evaluating and managing the illness and are one of the core codes for healthcare professionals, especially family physicians. The assistants of the family physicians’ assistants, nurse practitioners, or other qualified health professionals (QHP) can maximize the payment method.

In addition, it can help reduce stress, as seen with audits for the proper observance of documents and codes available for E/M services. The services of E/M include a whole category of CPT codes known as current procedural terminology used for billing purposes.

Most patients that visit for treatment require an E/M code that holds different levels. The patients have explained the levels of E/M codes. It depends on the complexity of the patient and the requirement of documentation.

cpt 99441

99441 CPT Code Billing Guidelines

The non-face-to-face telehealth visits of patients require some billing to continue these services. There are billing methods for the telephone services of CPT code 99441 – 99443. The non-face-to-face E/M services refer to CPT codes that qualified health professionals use. An established patient can make telephone calls having certain restrictions.

There is no billing for the patient who makes the call if the call ends up with the decision of a checkup in the next 24 hours or demands an urgent appointment.

A patient cannot use the telephone code if the call refers to the service of E/M reported by the qualified health professional within the previous seven days. The E/M visits get initiated through calls attempted by the patient or the guardian of the patient as described below:

99441 CPT code: 5-10 minutes of medical discussion through telecommunication route

99442: 11-20 minutes of medical discussion through telecommunication route

99442: 11-30 minutes of medical discussion through telecommunication route

The payments increased for the evaluation and management of the visits for CPT code 99441, 99442, and 99443. The payment rates are high, about $14 to $41 and $60 to $137 during the pandemic. The timings described above are according to the specific CPT codes. For example, each code has its specific timing in which the patient can use the 99441 code, and charges are revised for 5-10 minutes of discussion. 

There are specific guidelines related to the CPT coding system that we will discuss below:

Charging the extra amount: According to the rules of CPT, if the timing of services provided crosses their minimum time level by at least 15 minutes, physicians can charge for their extra services using a new CPT code 99417.

The primary procedure for telemedicine: CPT code 99417 is the code for charging extra after a prolonged timing situation and is a primary procedure for telemedicine. It helps the QHP or physicians dealing with the patient using the 99441 CPT code, and a person can bill each time for 15 minutes regarding the total time.

Determining the service level: This code is helpful for billing within the 15-minute increments used to determine the service level.

Discussion less than 15 minutes: The increments requiring less than 15 minutes are not under the 99441 CPT code.

Codes not billed: The patients with the CPT codes 99354, 99385, 99358, 99415, and 99416 are not billed by physicians under code 99417.

99441 CPT Code Modifiers and Reimbursement

There are service codes and modifiers related to telehealth services in which CR modifier is not necessary during billing. The telehealth billing claims some declarations that state:

POS or place of service should be the part according to the procedures given to the person.

When the patient is in their home, there is no need to use the place of service modifier 10. If a person is at any other location than home, the person can utilize the area of service modifier 02 

The service that took place through telehealth indicates through append modifier 95.

The CPT coding system and California business and profession code prohibit the recommendation of dangerous drugs without any appropriate indication. The exceptions included are:

The drugs are prescribed and dispensed to maintain the patient when the physician and surgeon are absent. Therefore, the physician, surgeon, or podiatrist’s license should be designated to look at the patient’s health until the practitioner returns.

99441 CPT Code Example

The following are examples of when the 99441 CPT code may be billed.

Example 1

A patient calls who has not been seen in the previous months and complains about the ant bite. The patient is concerned about the treatment and speaks to the physician, who has also treated the patient’s son with anaphylaxis to wasps.

The physician notifies the patient about the symptoms he should keep in mind and explains the kind of reactions that might occur. The physician recommends using an epinephrine autoinjector, and this whole conversation takes about 25 minutes. The 15 minutes are waiting minutes in which the staff called the pharmacy for the autoinjector.

Example 2

The patient chooses the code 99443 and gets the bill for the consultation and time of the physician. The problem was discussed on the phone, and the staff did not include the time required by the staff.

They claimed that the total discussion was on the telephone and the problem was discussed through telecommunication. They noted the discussion and indicated that the patient had no E/M visits and patiently spent 25 minutes on the discussion. 

Example 3

A patient has been suffering from allergic rhinitis for about three days and wakes up with hives on the body. She complains about the HIPAA portal and messages the doctor about the situation. The doctor’s assistant responds to the patient’s message, asks about the information related to the patient’s hives, activities, and lifestyle, and prescribes an anti-histamine.

This whole discussion took around ten minutes. After two days, the patient again sent a message and complained that the hives were not gone totally, but the condition was much better than before. She demands a strong medicine as prescribed earlier.

The personal assistant accepts the offer and prescribes a short course comprised of corticosteroids. He also explained the side effects that the patient might face after consuming these steroids. 

This whole discussion took about twelve minutes, and the patient did not call back and did not visit the hospital for a checkup for hives. This patient was charged against bill 99423 as the total duration of both calls was twenty-two minutes made within seven days.

The condition of hives was not related to the allergy condition of rhinitis. The document will state that there was no E/M visit, which will support the total time billed for the patient, which was spent on call for discussion and prescription. 

We can conclude that telemedicine is becoming an important part of our life and its use is still significant for treating and consulting the conditions of allergy and immunology even after the pandemic.

During the pandemic days, the commercial insurance companies made some special provisions for telehealth so that medical care should be available for all patients prone to sudden illness and symptoms.

But after the pandemic, the modes of telephone calls without video and through video connections and communications are lessening due to face-to-face telemedicine. 

It will be important to learn the codes and understand what codes different insurers require to be properly reimbursed for your work.

Remembering to get consent for visits, document what was done, adhere to medically necessary procedures, and code correctly will help practices receive payment for these services. It would be helpful to medicine in general if the commercial insurance companies and CMS provided a uniform approach and guideline for telemedicine coding.

Until such time that these stakeholders provide a consistent and uniform coding guide to telemedicine, remember that “it depends” as you select the appropriate code, modifier, and place of service for telemedicine encounters.

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