Michael Enos, CPC, CPMA

Doctors and practice administrators are always looking for how to maximize profits. As a coding/billing consultant, chart auditor, and educator, I’m often asked about ways to improve coding. Here are three codes that I find are often misunderstood, underused, or unknown. Practices that know about these codes-and how to use them-may be able to earn additional reimbursement.

Doctors’ offices are busy places, and it isn’t unusual for patients to call in asking to speak with the doctor. CPT offers codes to report telephone services provided by a physician or other qualified health care professional who may report evaluation and management (E/M) services. These codes can only be reported for an established patient and are not billable if the call results in the patient coming in for a face-to-face service within the next 24 hours (or next available urgent visit). These calls are also not billable if they refer to an E/M service performed within the last seven days. The codes are selected from code range 99441 to 99443 and are based on the time spent: 5-10 minutes, 11-20 minutes, or 21-30 minutes, respectively.

99058: Services provided on an emergency basis

What can you do when your providers already have a packed schedule and a patient walks in demanding to be seen? What if a scheduled nurse visit is more serious than anticipated, and the provider is called to step in and spend a great deal of time with that patient? When a patient is seen on an emergency basis in the office-and it disrupts other scheduled office services-you may be able to report add-on code 99058 for additional reimbursement.

Providers can bill code 96160 when they perform a health risk assessment with a patient or caregiver/guardian in order to assess the risk of conditions such as mental disorders. They can also report 96160 when administering a patient-focused health risk assessment. Providers should report 96161 for a caregiver-focused health risk assessment, such as depression inventory, for the benefit of the patient.

Mike Enos, CPC, CPMA, CPC-I, CEMC is a partner at Enos Medical Coding, based in Warwick, Rhode Island. He has more than 10 years of experience in medical coding, billing compliance, and revenue cycle management. He can be reached at 

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Author | Michael Enos, CPC, CPMA

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