How To Use CPT Code 99443

CPT 99443 refers to a telephone evaluation and management service provided by a physician or other qualified health care professional for an established patient, parent, or guardian, lasting 21-30 minutes. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99443.

1. What is CPT 99443?

CPT 99443 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 service must not originate from a related E/M service provided within the previous 7 days nor lead to an E/M service or procedure within the next 24 hours or soonest available appointment. The telephone conversation should last between 21 and 30 minutes.

2. 99443 CPT code description

The official description of CPT code 99443 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; 21-30 minutes of medical discussion.”

3. Procedure

The 99443 procedure involves the following steps:

1. The provider receives a call from an established patient, parent, or guardian with a new complaint.
2. The provider obtains a brief history from the caller.
3. The provider 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 99443 services includes:

• The caller must be an established patient, parent, or guardian.
• The call must not be related to an E/M service provided within the previous 7 days.
• The call must not lead to an E/M service or procedure within the next 24 hours or soonest available appointment.
• The telephone conversation must last between 21 and 30 minutes.

5. When to use CPT code 99443

It is appropriate to bill the 99443 CPT code 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 qualifying circumstances mentioned above.

6. Documentation requirements

To support a claim for CPT 99443, the following information must be documented:

• The date and time of the call.
• The duration of the call (21-30 minutes).
• A brief history obtained from the caller.
• The patient’s current list of medications reviewed.
• The medical decision made regarding recommended treatment.
• Any discussion with other providers, if applicable.

7. Billing guidelines

When billing for CPT code 99443, keep in mind the following guidelines and rules:

• Do not report 99441-99443 when using 99374-99380 for the same call(s).
• Do not report 99441-99443 for home and outpatient INR monitoring when reporting 93792 or 93793.
• Do not report 99441-99443 during the same month with 99487-99489.
• Do not report 99441-99443 when performed during the service time of codes 99495 or 99496.

8. Historical information

CPT 99443 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; 21-30 minutes of medical discussion.”

9. Similar codes to CPT 99443

Five similar codes to CPT 99443 and how they differentiate are:

• CPT 99441: Telephone evaluation and management service lasting 5-10 minutes.
• CPT 99442: Telephone evaluation and management service lasting 11-20 minutes.
• CPT 99444: Online evaluation and management service provided by a physician or other qualified health care professional.
• CPT 99445: Interprofessional telephone or internet consultation with a treating physician or other qualified health care professional, lasting 16-30 minutes.
• CPT 99446: Interprofessional telephone or internet consultation with a treating physician or other qualified health care professional, lasting 31-45 minutes.

10. Examples

Here are 10 detailed examples of CPT code 99443 procedures:

1. A patient with a history of hypertension calls the provider to discuss a sudden increase in blood pressure. The provider reviews the patient’s medications and recommends adjustments during a 25-minute call.
2. A parent calls the provider to discuss their child’s persistent cough and fever. The provider obtains a history and recommends over-the-counter medication during a 22-minute call.
3. A patient with diabetes calls the provider to discuss recent fluctuations in blood sugar levels. The provider reviews the patient’s medications and makes adjustments during a 28-minute call.
4. A patient with a history of migraines calls the provider to discuss a severe headache that has not responded to their usual medication. The provider recommends additional treatment options during a 23-minute call.
5. A patient recovering from surgery calls the provider to discuss concerns about their wound healing. The provider assesses the situation and provides wound care instructions during a 27-minute call.
6. A patient with a history of asthma calls the provider to discuss increased shortness of breath. The provider reviews the patient’s medications and recommends adjustments during a 30-minute call.
7. A patient with a history of depression calls the provider to discuss recent changes in mood and sleep patterns. The provider reviews the patient’s medications and recommends adjustments during a 24-minute call.
8. A parent calls the provider to discuss their child’s recent onset of a rash. The provider obtains a history and recommends over-the-counter treatment during a 21-minute call.
9. A patient with a history of chronic pain calls the provider to discuss increased pain levels. The provider reviews the patient’s medications and recommends adjustments during a 26-minute call.
10. A patient with a history of gastrointestinal issues calls the provider to discuss recent changes in bowel habits. The provider reviews the patient’s medications and recommends adjustments during a 29-minute call.