How To Use CPT Code 98967

CPT 98967 describes the telephone assessment and management service provided by a qualified nonphysician healthcare 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 billing examples.

1. What is CPT Code 98967?

CPT 98967 can be used to describe the telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent, or guardian. This code is used when the healthcare professional engages in a telephonic conversation with the patient, discussing a new health issue and possible treatment or management. The conversation should last between 11 and 20 minutes and should not be related to a 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.

2. Official Description

The official description of CPT code 98967 is: ‘Telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.’

3. Procedure

1. The nonphysician healthcare professional engages in a telephonic conversation with the established patient, parent, or guardian.
2. During the conversation, the healthcare professional listens and responds to the patient’s health concerns, answers any medical questions, and recommends management.
3. The conversation should last between 11 and 20 minutes and should not be related to a 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.
4. The healthcare professional documents the encounter in the patient’s record, including the topics discussed and any recommendations made.

4. Qualifying circumstances

CPT 98967 is applicable when the patient, parent, or guardian initiates the telephone contact to discuss a new health issue. The conversation should not be related to a 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 patient should be an established patient, meaning they have seen the same physician or qualified healthcare practitioner within the past 36 months.

5. When to use CPT code 98967

CPT code 98967 should be used when a qualified nonphysician healthcare professional engages in a telephonic conversation with an established patient, parent, or guardian to discuss a new health issue. The conversation should last between 11 and 20 minutes and should not be related to a 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.

6. Documentation requirements

To support a claim for CPT 98967, the healthcare professional must document the following information:

• Initiation of the telephone contact by the patient, parent, or guardian
• Specific topics discussed during the conversation
• Recommendations made by the healthcare professional
• Date and duration of the telephonic conversation
• Signature of the qualified nonphysician healthcare professional providing the service

7. Billing guidelines

When billing for CPT 98967, ensure that the healthcare professional providing the service is a qualified nonphysician professional. The telephonic conversation should last between 11 and 20 minutes and should not be related to a 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. It is important to check with individual insurance companies to verify their reimbursement guidelines for this code.

8. Historical information

CPT 98967 was added to the Current Procedural Terminology system on January 1, 2008. There was a code change on January 1, 2009, which modified the description of the code to include the specific time range of 11-20 minutes for the telephonic conversation.

9. Examples

1. A nurse discussing a new health issue and providing recommendations to an established patient during a 15-minute telephonic conversation.
2. A physician assistant answering medical questions and advising a parent on managing their child’s illness during a 12-minute telephonic conversation.
3. A nurse practitioner discussing treatment options and providing guidance to an established patient during a 19-minute telephonic conversation.
4. A physical therapist providing instructions and exercises to an established patient for managing their pain during a 17-minute telephonic conversation.
5. A trained social worker offering counseling and support to an established patient during a 14-minute telephonic conversation.
6. A respiratory therapist discussing breathing techniques and providing education to an established patient during a 13-minute telephonic conversation.
7. A nurse providing guidance on medication management and lifestyle changes to an established patient during a 16-minute telephonic conversation.
8. A physician assistant addressing a patient’s concerns and recommending further evaluation during a 20-minute telephonic conversation.
9. A physical therapist providing advice on home exercises and modifications to an established patient during a 18-minute telephonic conversation.
10. A trained social worker offering coping strategies and resources to an established patient during a 11-minute telephonic conversation.