How to Bill an "On Call" Call

First, a disclaimer: the reimbursement rules around telephone visits are complex, vary from state to state, and are almost universally discouraged in favor of video visits (or in person visits).

But sometimes phone calls happen.

And sometimes, those phone calls happen while “on call.”

So, what’s the best practice for how to document these phone calls?

(Of course, check with your practice’s finances department, but here’s what I’ve learned about the process).

Second, another disclaimer: how you handle weekend and overnight calls is going to be largely dependent on how you’re group handles weekend and overnight calls.

For some practices, this means operating as if the office is open – answering questions, reviewing labs, ordering medications, and so on. For other practices, this means redirecting to the E.R. or next available appointment.

“How to Be a Rock Star Doctor” encourages providers to avoid diagnosing and treating medical conditions over the phone and redirecting patients to the E.R. (if emergent) or to call the office during business hours (if non-emergent).

If you’re worried enough to call the doctor, you need to be seen and examined by a physician.

For when those "on call" calls still happen, telephone encounters are billed using LOS codes 99441 – 99443.

In order to submit for one of these codes, the following criteria must be met:

1. The patient must initiate request for care and consent to care by phone.
2. A minimum of 5 minutes must be spent during that telephone call.
3. The encounter cannot originate from a related E&M service within the previous 7 days, or lead to an E&M service within the next 24 hours or soonest available.

Here’s what that might look like in practice:

And remember to document a short statement of criteria fulfillment, such as this:

Patient initiated request for care and consented to telephone care. I spent *** minutes during the care of the patient.

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