January 21, 2015

Provided by Jacqueline Thelian, CPC, CPC-I, CHCA, President of Medco Consultants

Good Morning Jennifer:

When I saw this question (Charging for "abnormal" results call ok?) I felt compelled to write a response.

The time for the “call” with the patient to discuss abnormal test results is defined by CPT (Current Procedural Terminology) as “post-service” work for an E/M (office visit) and is therefore included in the reimbursement for the office visit.

This is found in CPT in the E/M Guidelines and states the following, “ Time is also spent doing work before or after the face-to-face time with the patient, performing such tasks as reviewing records and tests arranging for further services, and communicating further with other professionals and the patient through written reports and telephone contact.” “This non face to face time for office services – also called pre and post encounter time is not included in the time component described in E/M codes. However the pre and post non face-to-face work associated with an encounter was included in calculating the total work of typical services in physician surveys”

Therefore the physician got paid for the communication with the patient when he/she was paid for the office visit. Additionally if the physician was thinking of charging for a telephone call, he/she should think again. As the guidelines for telephone services clearly state  
 “if the telephone call refers to an E/M (office visit) service performed and reported by that individual within the previous seven days (either requested or unsolicited patient follow-up) or within the post-operative period of the previously completed procedure, then the service(s) are considered part of that previous E/M service or procedure”

I do understand that money is tight for most physician/providers however understanding the coding system will allow the physicians/providers to stay complaint and obtain appropriate reimbursement for the services provided.

Jacqueline Thelian, CPC, CPC-I, CHCA
Medco Consultants, Inc. 
Phone: 718-217-3802  


Provided by Theresa Wilson CMRS, CMBP, CEO of Practice Synergy, LLC = 


You are absolutely correct!  A physician should definitely have the patient return to the office to review any abnormal test results and to discuss what to do next – this would be a billable visit to insurance and also require the patient to pay their co-pay or cost share portion.  But a contracted physician cannot bill the patient for a phone call to relay news of an abnormal test result.  You can, however,  incorporate this type of service under the new chronic care management codes payable by Medicare in 2015, if the services meet the established requirements.  Here’s a very informative article on these new codes: http://www.pyapc.com/resources/collateral/white-papers/Chronic-Care-Whitepaper-PYA.pdf

Theresa Wilson CMRS, CMBP
Practice Synergy, LLC 
45 Carey Ave., Suite 101 
Butler, NJ 07405 
862-210-8008 x101
862-772-1877 fax
201-978-7277 cell


Then send the results to the patient and state the office practice is not to discuss this on the phone for it will take time from pother patients[attorneys bill for telephone time], and to come in to consider the actions as to what should be done with the results. This will code as a brief office visit.

But what if assignment was not accepted with that blood draw visit. The blood draw could be free and the results cost.

Richard S. Blum, M.S., M.D., F.C.P.,F.A.C.P. 
Physician Advisor, Member of IRB and Chairman of P&T, St. Francis Hospital 
Assistant Professor of Clinical Medicine, SUNY Stony Brook 
Consultant to the FDA 
Professor of Pharmacology Long Island University 
Member Board of Governors’ of the Chicago Medical School 
Member United States Pharmacopoeia 
Former Chairman New York State DUR Board 


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Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.