Author: GDIT (800) 688-6696
In response to the higher than normal number of influenza cases and influenza-related complications and deaths, NC Medicaid is offering telephonic evaluation and management (E/M) services to beneficiaries who are actively experiencing flu-like symptoms. The purpose of this service is to decrease the spread of the influenza virus by encouraging ill beneficiaries to stay home and out of doctor offices, urgent cares and emergency departments.
Telephonic E/M services must be rendered by a physician, nurse practitioner or physician assistant actively enrolled in Medicaid and NCTracks. Services are only to be rendered to established patients or legal guardian of an established patient.
Telephonic E/M services are not to be reported if clinical decision making dictates a need to see the beneficiary within 24 hours for an office visit or next available urgent care appointment; the telephone consultation shall be considered a part of the office visit. If the telephone call follows an office visit performed and reported within the past seven calendar days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately reported.
CPT Codes to be reported for telephonic evaluation and management services include:
- 99441: Telephone evaluation and management service by a physician or other qualified healthcare 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 seven 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.
- 99442: 11-20 minutes of medical discussion.
- 99443: 21-30 minutes of medical discussion.
ICD-10 diagnosis codes to be reported with telephonic evaluation and management services include:
- Z20.828: Contact with and (suspected) exposure to other viral communicable disease.
Dates of service for reporting of telephonic E/M codes coincide with the annual flu season. Claims for telephonic calls related to flu-like illness will be accepted for dates of service on or after Feb. 1, 2020, and denied for dates of service after April 30, 2020.