How To Use CPT Code 98966

CPT 98966 is a code used for telephone assessment and management services provided by qualified nonphysician healthcare professionals to established patients. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 98966.

1. What is CPT 98966?

CPT 98966 is a code used to report telephone assessment and management services provided by qualified nonphysician healthcare professionals to established patients, parents, or guardians. This code is used when the service is not related to an assessment and management service provided within the previous seven days or leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment. The service includes 5-10 minutes of medical discussion.

2. 98966 CPT code description

The official description of CPT code 98966 is: “Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.”

3. Procedure

The 98966 CPT code procedure involves the following steps:

1. The patient, parent, or guardian initiates a phone call to the nonphysician healthcare professional.
2. The healthcare professional listens to the patient’s health concerns and answers any medical questions.
3. The healthcare professional recommends management or treatment options based on the patient’s condition.
4. The healthcare professional documents the encounter in the patient’s medical record, including the duration of the call and the topics discussed.

4. Qualifying circumstances

Eligibility for CPT code 98966 services includes the following circumstances:

• The patient is an established patient, parent, or guardian.
• The service is provided by a qualified nonphysician healthcare professional, such as a nurse, physician assistant, nurse practitioner, physical therapist, respiratory therapist, or trained social worker.
• The telephone assessment and management service is not related to an assessment and management service provided within the previous seven days or leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment.
• The duration of the medical discussion is between 5 and 10 minutes.

5. When to use CPT code 98966

It is appropriate to bill the 98966 CPT code when a qualified nonphysician healthcare professional provides a telephone assessment and management service to an established patient, parent, or guardian, and the service is not related to a recent or upcoming assessment and management service or procedure. The medical discussion should last between 5 and 10 minutes.

6. Documentation requirements

To support a claim for CPT 98966, the following information should be documented:

• The patient’s name and relationship to the patient (if applicable).
• The date and time of the telephone encounter.
• The duration of the medical discussion.
• A summary of the patient’s health concerns and questions.
• The healthcare professional’s recommendations for management or treatment.
• Any follow-up appointments or referrals made during the call.

7. Billing guidelines

When billing for CPT code 98966, keep in mind the following guidelines and tips:

• Verify current guidelines with individual insurance companies, as some payers may not reimburse for CPT 98966.
• Document the time spent on the call, as CPT 98966 and related codes are based on time.
• Ensure that the patient or patient guardian initiated the phone contact before reporting CPT 98966.
• Do not submit CPT 98966 if the call is within seven days of a previous E/M service, within the postoperative period from a previous procedure or surgery, or if the patient is seen within the next 24 hours.

8. Historical information

CPT 98966 was added to the Current Procedural Terminology system on January 1, 2008. The code was changed on January 1, 2009, with the previous descriptor being the same as the current descriptor.

9. Similar codes to CPT 98966

Five similar codes to CPT 98966 and how they differ are:

1. CPT 98967: This code is used for the same service as CPT 98966 but involves 11 to 20 minutes of medical discussion.
2. CPT 98968: This code is used for the same service as CPT 98966 but involves 21 to 30 minutes of medical discussion.
3. CPT 99441: This code is used for telephone evaluation and management services provided by a physician to an established patient, parent, or guardian, involving 5 to 10 minutes of medical discussion.
4. CPT 99442: This code is used for the same service as CPT 99441 but involves 11 to 20 minutes of medical discussion.
5. CPT 99443: This code is used for the same service as CPT 99441 but involves 21 to 30 minutes of medical discussion.

10. Examples

Here are 10 detailed examples of CPT code 98966 procedures:

1. A nurse practitioner discusses a patient’s new rash over the phone and recommends over-the-counter treatment options. The call lasts 8 minutes.
2. A physician assistant provides guidance to a parent on managing their child’s fever during a 6-minute phone call.
3. A respiratory therapist discusses inhaler usage and technique with a patient during a 10-minute phone call.
4. A physical therapist provides recommendations for at-home exercises to a patient recovering from a knee injury in a 7-minute phone call.
5. A trained social worker discusses coping strategies for stress management with a patient during a 9-minute phone call.
6. A nurse provides dietary advice to a patient with newly diagnosed diabetes in an 8-minute phone call.
7. A physician assistant discusses medication side effects and possible adjustments with a patient during a 5-minute phone call.
8. A nurse practitioner provides guidance on wound care to a patient recovering from surgery in a 10-minute phone call.
9. A respiratory therapist discusses sleep apnea management strategies with a patient during a 6-minute phone call.
10. A physical therapist provides recommendations for modifying daily activities to reduce back pain in a 7-minute phone call.