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Scenario B is billable and should be coded as G2012. The ICD-10 is M06.09.
As of January 2019, the Centers for Medicare & Medicaid Services has allowed a new code to be billed for a brief communication for virtual check-in by a physician or a qualified healthcare professional who can provide an evaluation and management (E/M) service with an established patient. This can be done by phone or video. The encounter may be billed only if it does not result in an E/M visit within seven days or if the patient was seen within seven days prior to the virtual check-in encounter. Scenario A does not qualify because the call resulted in an E/M visit the next day.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at mtillman@rheumatology.org or call 404-633-3777 x820.