How To Use CPT Code 99441

CPT 99441 is a code used for telephone evaluation and management services provided by a physician or other qualified healthcare professional to an established patient. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99441.

1. What is CPT 99441?

CPT 99441 is a code used to represent telephone evaluation and management services provided by a physician or other qualified healthcare professional to an established patient, parent, or guardian. This code is specifically 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 duration of the medical discussion should be between 5-10 minutes.

2. 99441 CPT code description

The official description of CPT code 99441 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; 5-10 minutes of medical discussion.”

3. Procedure

The 99441 CPT code procedure involves the following steps:

1. The established patient, parent, or guardian contacts the provider with a new complaint or concern.
2. The provider obtains a brief history from the patient and reviews their current list of medications.
3. The provider makes a medical decision regarding the recommended treatment, with a note to call if symptoms do not improve.
4. The provider documents the specifics and the amount of time for the discussion in the patient’s chart.
5. Discussion with other providers, if necessary, is included in the code.

4. Qualifying circumstances

Eligibility for CPT code 99441 services includes the following circumstances:

• The patient must be an established patient, parent, or guardian.
• The telephone evaluation and management service must not be related to an E/M service provided within the previous seven days.
• The service must not lead to an E/M service or procedure within the next 24 hours or soonest available appointment.
• The medical discussion must last between 5-10 minutes.

5. When to use CPT code 99441

It is appropriate to bill the 99441 CPT code when a physician or other qualified healthcare professional provides a telephone evaluation and management service to an established patient, parent, or guardian, and the service meets the qualifying circumstances mentioned above.

6. Documentation requirements

To support a claim for CPT 99441, the following information must be documented:

• The patient’s name and relationship to the patient (if applicable).
• The date and time of the telephone call.
• A brief history of the patient’s complaint or concern.
• The provider’s medical decision and recommended treatment.
• The duration of the medical discussion (5-10 minutes).
• Any discussion with other providers, if applicable.

7. Billing guidelines

When billing for CPT code 99441, keep in mind the following guidelines and tips:

• Ensure that the service meets all qualifying circumstances before billing.
• Document all required information to support the claim.
• Use time to choose among 99441, 99442, and 99443, as these codes are differentiated based on the duration of the medical discussion.

8. Historical information

CPT 99441 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; 5-10 minutes of medical discussion.”

9. Similar codes to CPT 99441

Five similar codes to CPT 99441 and how they differentiate are:

• CPT 99442: This code is used for telephone evaluation and management services lasting 11-20 minutes.
• CPT 99443: This code is used for telephone evaluation and management services lasting 21-30 minutes.
• CPT 99444: This code is used for online evaluation and management services provided by a physician or other qualified healthcare professional.
• CPT 99445: This code is used for interprofessional telephone or internet consultation services provided by a physician or other qualified healthcare professional.
• CPT 99446: This code is used for interprofessional telephone or internet consultation services provided by a physician or other qualified healthcare professional, lasting 5-10 minutes of medical consultative discussion and review.

10. Examples

Here are 10 detailed examples of CPT code 99441 procedures:

1. A patient with a history of hypertension calls their physician to discuss a sudden increase in blood pressure. The physician reviews the patient’s medications and recommends a change in dosage during a 7-minute call.
2. An established patient calls their primary care provider to discuss new symptoms of a persistent cough and fever. The provider takes a brief history and recommends over-the-counter medication during a 6-minute call.
3. A parent calls their child’s pediatrician to discuss concerns about their child’s recent ear pain. The pediatrician recommends a home remedy and advises the parent to call back if symptoms worsen during an 8-minute call.
4. A patient with diabetes calls their endocrinologist to discuss recent fluctuations in blood sugar levels. The endocrinologist reviews the patient’s current insulin regimen and makes adjustments during a 9-minute call.
5. An established patient calls their dermatologist to discuss a new rash. The dermatologist recommends an over-the-counter cream and advises the patient to schedule an appointment if the rash does not improve within a week during a 5-minute call.
6. A patient with a history of migraines calls their neurologist to discuss a recent increase in headache frequency. The neurologist reviews the patient’s current medications and recommends a new treatment plan during a 10-minute call.
7. A patient with a history of anxiety calls their psychiatrist to discuss recent panic attacks. The psychiatrist reviews the patient’s current medications and recommends a change in dosage during a 7-minute call.
8. An established patient calls their gastroenterologist to discuss new symptoms of abdominal pain and bloating. The gastroenterologist recommends dietary changes and advises the patient to call back if symptoms do not improve during an 8-minute call.
9. A patient with a history of asthma calls their pulmonologist to discuss recent shortness of breath. The pulmonologist reviews the patient’s current medications and recommends a change in inhaler usage during a 6-minute call.
10. An established patient calls their rheumatologist to discuss new joint pain and swelling. The rheumatologist recommends over-the-counter medication and advises the patient to schedule an appointment if symptoms worsen during a 9-minute call.