Question: We had a patient that called in and left a message for the doctor to contact her about a visit she had for bronchitis just over a week ago. The doctor called her back and they had a 10-minute discussion about how she was feeling. She stated that she was feeling much better but still had a bit of a lingering cough. The doctor refilled her antibiotic and told her to make an appointment in a week if she still has any symptoms, or sooner if she starts to feel worse. He wants to report 98008. Is that the right code?
Answer: Great question! CPT® code 98008, Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded is a phone call code, but it is not appropriate in this case. I highlighted the times for the code and as you can see, for 98008 to be reported there must be more than 10 minutes of medical discussion and a total of 15 minutes must be met to report it.
The appropriate code to report in this case would be the virtual check-in call, 98016, Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion. To report 98016, the patient must be established, the contact must be generated from the patient, the time threshold must be met, and it can’t result from a visit in the prior 7 days or lead to a visit in the next 24 hours (or soonest available). The situation you described falls into that code perfectly. Make sure that the physician documents the nature of the discussion, that it was patient generated, and the total time spent on medical discussion for support.
*NOTE: This response is current in February 2025. As guidelines and payor guidance may change, please be sure to check if it is still valid when you are reading this issue.
