This month’s Coding Nuggets were provided by Jeannie C. Cagle, BSN, RN, CPC, a senior consultant of The Coker Group with more than 20 years experience in clinical health. The Coker Group is an SMA approved partner.

Question

Our physician spends many hours on the phone talking to patients and with other physicians in the course of doing a neurology consult. How can I bill for the time she spends on the phone?

• Answer

  Lots of folks were excited to see the telephone evaluation codes in the CPT book (99441-99443), but that doesn’t mean they will be paid. The status indicator for these fees in the Medicare Physician Fee Schedule Data Base instruct either “B” for bundled or “N” for non-covered, meaning Medicare won’t pay separately for these. Chances are your other commercial insurances won’t either. I’ve yet to hear of anyone being reimbursed for these new codes.

Question

When our physician sees Medicare patients, he’d like to run blood work to get a baseline but we can’t use, for example, hyperlipidemia for a cholesterol test until we run the test to know if they have hyperlipidemia. Does the patient have to pay for these tests without a covered diagnosis and should they sign an ABN?

• Answer

  Actually, screening cardiovascular tests began to be covered in 2005 by Medicare with the introduction of the ‘Welcome to Medicare’ service.  Here is what Medicare covers for cardiovascular screening:

  • Coverage is provided for the following tests:
    • Total cholesterol test;
    • Cholesterol test for high density lipoproteins; and
    • Triglycerides test
  • The beneficiary must fast for 12 hours before having these tests. The tests should be ordered as a lipid panel, but may be ordered separately.
  • Cardiovascular screening blood tests must be ordered by the physician or qualified non-physician practitioner treating the beneficiary for the purpose of early detection of cardiovascular disease. The beneficiary must have no apparent signs or symptoms of cardiovascular disease.
  • There is no deductible or copayment applied to this benefit, so the beneficiary will pay nothing to receive these blood tests.
  • Medicare covers cardiovascular screening blood tests every 5 years for beneficiaries with no apparent signs or symptoms of the disease.
  • Coverage is not available for other cardiovascular screening blood tests.

  For more information go to the CMS website: http://www.cms.hhs.gov/CardiovasDiseaseScreening/