The CPT Assistant, October 2013 Newsletter reported that with advancements in communication technology, the delivery of health care services have continued to evolve, prompting the creation of a new set of Current Procedural Terminology (CPT®) codes to report interprofessional telephone and Internet consultations.
For that purpose, four new codes and corresponding guidelines were added to the CPT 2014 code set to provide a methodology for subspecialists to report telephone consultative advice provided to a patient’s primary care provider rather than directly to the patient him or herself.
This article will discuss the correct use of the four new codes listed below:
- 99446-Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
- 99447-11-20 minutes of medical consultative discussion and review
- 99448-21-30 minutes of medical consultative discussion and review
- 99449-31 minutes or more of medical consultative discussion and review
An interprofessional telephone/Internet consultation is an assessment and management service in which a patient’s treating (eg, attending or primary) physician or other qualified health care professional requests the opinion and/or treatment advice of a physician with specific specialty expertise (the consultant) to assist the treating physician or other qualified health care professional in the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consultant.
These services may also be reported when an interprofessional telephone/Internet consultation is requested for either a new patient to the consultant, an established patient with a new problem, or an exacerbation of an existing problem. However, the consultant should not have seen the patient in a face-to-face encounter within the last 14 days (in which case the service is considered part of the post-service work of that face-to-face encounter). When the telephone/Internet consultation leads to an immediate transfer of care or other face-to-face service (eg, a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes are not reported.
The following information should be documented in order to report these codes:
- The written or verbal request for telephone/Internet advice by the treating/requesting physician or other qualified health care professional
- A written report from the consultant to the treating/requesting physician or other qualified health care professional which includes the content of the verbal consultative discussion and recommendations.
- Documentation of the time spent in discussion, preferably in the written report to the treating physician.
Review of pertinent medical records such as laboratory studies, imaging studies, medication profile, pathology specimens, and other patient data is included in the telephone/Internet consultation service and should not be reported separately. This review should be performed immediately before or after the telephone/Internet consultation. The majority of the service time reported (greater than 50%) must be devoted to the medical consultative verbal/Internet discussion. This service should not be reported more than once within a seven-day interval.
If more than one telephone/Internet contact is required to complete the consultation request, the entirety of the service and the cumulative discussion and information review time should be reported with a single code. Telephone/Internet consultations of less than five minutes should not be reported. These codes should not be reported if the sole purpose of the telephone/Internet communication is to arrange a transfer of care or other face-to-face service.
ADVOCATE will continue to provide information on this topic and others impacting radiology as they arise.
Jennifer Bash, RHIA, CPC, CIRCC, RCC
Coding Documentation & Education Manager