Just a few years ago, it was almost impossible to find a doctor who would spend time with patients on the telephone, and email was almost out of the question.
Why? Because doctors couldn't get paid for the time they spent doing either activity, even when they were dispensing medical advice.
Has that situation improved? What is the status of patients engaging with their doctors through phone calls and emails?
Before 2009, if you asked doctors why they wouldn't spend time on the phone or exchange email with their patients, they might reply that they couldn't get paid for the time. They cited the fact that there was no CPT code they could bill with.
(To better understand how this works, read this article on the basics of CPT codes.)
With no CPT code, there was no way to let your insurer know that time had been spent. You weren't in the doctor's office, so as far as your insurance company was concerned, no service was delivered.
That began to change when the AMA developed new CPT codes to allow for time spent on the phone and with email. Called "Non-Face-to-Face Services" the new CPT codes allow a doctor to account for the time spent on the phone with a patient, or using email, in increments of time (5 minutes, 10 minutes and so forth.) Not only that, the CPT codes were developed for both the physician and "non-physician providers" such as physician assistants and nurse practitioners. (Here are the phone and email CPT and HCPCS codes.)
It seemed that the doors were finally opened for this type of quick and useful communication.
But - not so fast! Many doctors still won't spend time on the phone with their patients, and even fewer will exchange email with patients - because development of the CPT codes was only part of the problem.
As mentioned above - insurers are half the pay-the-doctor equation. Just because the CPT codes had been developed didn't mean health insurance companies would reimburse for them. Many still won't. And now it's just confusing. Some insurers will reimburse, some won't reimburse, and even within the same company, plans might be different from each other.
That puts your doctor in a difficult position. Suppose she gets back to her desk at the end of a long day, and finds a handful of voicemails to return, and a dozen emails from her patients. She either has to return them -- or ignore them. And unless she knows exactly what each patient's insurance company says about reimbursement, she won't know whether her time can be reimbursed.
Further, she's faced with a dilemma. Does she spend the next couple of hours returning those calls and emails? Maybe get paid or maybe not.... Or does she go home to her spouse and children? Which would you choose?
Then, even when health insurance will reimburse, if your doctor decides to go ahead and talk to you by phone or reply to your email, there are strict rules that must be followed to determine whether she can be paid for the time spent on the phone or emailing with you.
Here are the rules your doctor or other provider must follow to use these codes for reimbursement:
- You (the patient or parent / guardian) must be the originator of the phone call or email. The doctor may not start the exchange (call or email you first).
- You (the patient) must be an established patient with the doctor's practice.
- The email or phone CPT code may not be used if is part of a follow-up to a surgery or procedure, if the patient has visited the doctor within 7 days before the call or email, or if the patient is seen within 24 hours (or an emergency appointment) of the phone call or email.*
- The call or email must be thoroughly documented and the documentation time cannot be included in the actual talk or keyboarding time. So if your doctor spends 10 minutes on the phone with you, then spends 10 minutes recording notes about the conversation, she will only be paid for the 10 minutes on the phone.
*If the call takes place in those 7 days before the phone call or email, or that "urgent" time just after the phone call or email, then the time used is considered to be part of which ever service triggered the contact, or is triggered because of the contact. There is no additional reimbursement for it using these codes.
It's no wonder it's still difficult to engage in a phone conversation or exchange email with a doctor! Most have too much trouble coordinating them and tracking them and making sure they are adhering to the rules.
A few final points about CPT code reimbursements for phone or email exchanges with your doctor:
- In addition to all the confusion over reimbursements, some doctors will tell you they are leery of using email because they have been told it is not secure (from a cyber-security perspective.) Some may tell you that email cannot be used because it's a violation of HIPAA laws. (That's not correct.) It's difficult to know whether security is a real reason, or if it's a substitute reason for the fact that the doctor can't get paid.
- As of the writing of this article (January 2011), Medicare is not yet reimbursing doctors for telephone or email time through its system of HCPCS codes. So far as I can tell, no states are reimbursing for email or phone calls through their Medicaid programs either.
- Despite all this confusion, you may want to try to convince your doctor to return phone calls or email anyway. Here is a step-by-step approach to communicating with your doctor by phone or email.