How To Use CPT Code 99442

CPT 99442 is a code for telephone evaluation and management services provided by a physician or other qualified health care professional to an established patient, parent, or guardian. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99442.

1. What is CPT 99442?

CPT 99442 is a code used to report telephone evaluation and management services provided by a physician or other qualified health care professional to an established patient, parent, or guardian. The code is used when the service is not related to an E/M service provided within the previous seven days and does not lead to an E/M service or procedure within the next 24 hours or soonest available appointment. The telephone conversation must last between 11 and 20 minutes.

2. 99442 CPT code description

The official description of CPT code 99442 is: “Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.”

3. Procedure

1. The provider receives a call from an established patient, parent, or guardian with a new complaint.
2. The call must not be related to an E/M service provided within the last seven days and cannot trigger an appointment within 24 hours or at the earliest available time.
3. The provider obtains a brief history from the patient and reviews the patient’s current list of medications.
4. The provider makes a medical decision regarding recommended treatment, with a note to call if symptoms do not improve.
5. The provider documents the specifics and the amount of time for the discussion in the patient’s chart.
6. Discussion with other providers is included in the code.

4. Qualifying circumstances

Eligibility for CPT code 99442 services includes established patients, parents, or guardians who require a telephone evaluation and management service by a physician or other qualified health care professional. The service must not be related to an E/M service provided within the previous seven days and cannot lead to an E/M service or procedure within the next 24 hours or soonest available appointment. The telephone conversation must last between 11 and 20 minutes.

5. When to use CPT code 99442

It is appropriate to bill CPT code 99442 when a physician or other qualified health care professional provides a telephone evaluation and management service to an established patient, parent, or guardian, and the call meets the specific criteria mentioned in the code description. The call must not be related to an E/M service provided within the last seven days and cannot trigger an appointment within 24 hours or at the earliest available time. The telephone conversation must last between 11 and 20 minutes.

6. Documentation requirements

To support a claim for CPT 99442, the following information must be documented:

• The date and time of the telephone call.
• The duration of the call (11-20 minutes).
• A brief history obtained from the patient.
• The patient’s current list of medications reviewed.
• The medical decision made regarding recommended treatment, with a note to call if symptoms do not improve.
• Any discussion with other providers, if applicable.

7. Billing guidelines

When billing for CPT code 99442, it is essential to ensure that the service provided meets the specific criteria mentioned in the code description. The telephone conversation must last between 11 and 20 minutes, and the call must not be related to an E/M service provided within the last seven days or lead to an E/M service or procedure within the next 24 hours or soonest available appointment. Proper documentation is crucial to support the claim, as outlined in the documentation requirements section.

8. Historical information

CPT 99442 was added to the Current Procedural Terminology system on January 1, 2008. The code was changed on January 1, 2013, with the previous descriptor being: “Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.”

9. Similar codes to CPT 99442

Five similar codes to CPT 99442 and how they differentiate are:

1. CPT 99441: This code is for telephone evaluation and management services lasting 5-10 minutes.
2. CPT 99443: This code is for telephone evaluation and management services lasting 21-30 minutes.
3. CPT 99444: This code is for online evaluation and management services provided by a physician or other qualified health care professional.
4. CPT 99445: This code is for interprofessional telephone or internet consultation services provided by a physician or other qualified health care professional.
5. CPT 99446: This code is for interprofessional telephone or internet consultation services provided by a physician or other qualified health care professional, lasting 5-10 minutes.

10. Examples

Here are ten detailed examples of CPT code 99442 procedures:

1. A patient calls their primary care physician with concerns about a new rash. The physician spends 15 minutes discussing the rash, reviewing the patient’s medications, and providing treatment recommendations.
2. A parent calls their child’s pediatrician with concerns about their child’s fever and cough. The pediatrician spends 12 minutes discussing the symptoms, reviewing the child’s medical history, and providing treatment recommendations.
3. A patient with diabetes calls their endocrinologist to discuss recent fluctuations in their blood sugar levels. The endocrinologist spends 18 minutes discussing the patient’s concerns, reviewing their medications, and adjusting their treatment plan.
4. A patient with hypertension calls their cardiologist to discuss recent changes in their blood pressure readings. The cardiologist spends 13 minutes discussing the patient’s concerns, reviewing their medications, and providing treatment recommendations.
5. A patient with a history of migraines calls their neurologist to discuss a recent increase in migraine frequency. The neurologist spends 16 minutes discussing the patient’s concerns, reviewing their medications, and adjusting their treatment plan.
6. A patient with a history of depression calls their psychiatrist to discuss recent changes in their mood. The psychiatrist spends 19 minutes discussing the patient’s concerns, reviewing their medications, and providing treatment recommendations.
7. A patient with a history of asthma calls their pulmonologist to discuss recent changes in their breathing. The pulmonologist spends 14 minutes discussing the patient’s concerns, reviewing their medications, and providing treatment recommendations.
8. A patient with a history of gastrointestinal issues calls their gastroenterologist to discuss recent changes in their symptoms. The gastroenterologist spends 17 minutes discussing the patient’s concerns, reviewing their medications, and providing treatment recommendations.
9. A patient with a history of rheumatoid arthritis calls their rheumatologist to discuss recent changes in their joint pain. The rheumatologist spends 11 minutes discussing the patient’s concerns, reviewing their medications, and providing treatment recommendations.
10. A patient with a history of allergies calls their allergist to discuss recent changes in their allergy symptoms. The allergist spends 20 minutes discussing the patient’s concerns, reviewing their medications, and providing treatment recommendations.