Interprofessional Telephone/Internet Consultation

After more than 10 years in the making, 4 codes debuted in the 2014 CPT Manual that allow consulting physicians to report telephone/internet assessment and management services with other physicians or qualified healthcare professionals (QHP) who contact them for help. The consulting physician should report these codes (99446, 99447, 99448, 99449) under the following circumstances:

1. The patient’s primary care or attending physician or qualified healthcare professional contacts the consulting physician for advice.
2. The consulting physician:
   a) Has not seen the patient within 14 days or has NEVER seen the patient.
   b) Will not see the patient within 14 days or next available appointment
   c) If the patient is established to the consulting physician, the problem must be new or worsening, and (a) and (b) still apply.
   d) Must provide a written or electronic report to the primary care or referring physician or qualified healthcare professional (QHP).
3. At least ½ of the reported time must be the telephone/internet consultation. The other time may be consumed in records review.
4. The telephone/internet consultation must be > 5 minutes.
5. The primary care or attending physician may report the call using other code(s) as appropriate, such as E/M and prolonged services codes (99354-99359).

This code is designed to report services when one spends more than 5 minutes on the phone/internet advising another professional how to take care of that professional’s patient. These codes may be used for scheduled telephone/internet case reviews or calls when the primary care physician or other QHPs has the patient in his/her office and is wondering what to do next.

Table 7. Interprofessional telephone/internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating or requesting physician or qualified healthcare professional

Who can bill for this?

Source: https://acpinternist.org/

The consulting physician is the one who bills this service, not the physician who requested the consult. The consulting physician offers specific specialty expertise that will 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 and consultant to meet face-to-face.

The services will typically be provided in complex and/or urgent situations where a timely face-to-face service with the consultant may not be possible. The written or verbal request, its rationale, and the conclusion for telephone/Internet advice by the treating/requesting physician or other qualified health care professional should be documented in the patient’s medical record.

Transfer of Care

The codes must not be reported by a consultant who has agreed, before the telephone/Internet assessment, to accept a transfer of care. However, if the decision to accept a transfer of care cannot be made until after the initial interprofessional telephone/Internet consultation, the codes are appropriate to report.

The patient may be either new to the consultant or an established patient with a new problem or an exacerbation of an existing problem. However, the patient should not have been seen by the consultant in a face-to-face encounter within the previous 14 days.

Do not report the codes when the telephone/Internet consultation leads to an immediate transfer of care or other face-to-face service (e.g., a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days. When multiple telephone/Internet contacts are required to complete the consultation request (e.g., discussion of test results), the cumulative service and review time should be reported with a single code.

Consults of less than 5 mins

Telephone/Internet consults of less than 5 minutes should not be reported. Consultant communications with the patient and/or family may be reported using 99441, 99442, 99443, 99444, 98966, 98967, 98968 or 98969, and the time related to these services is not used in reporting interprofessional telephone/Internet consult codes 99446, 99447, 99448 or 99449.

CPT® Rules – Physician Only

CPT^® rules for reporting interprofessional telephone/Internet Electronic Health Record Consultations by a consulting physician

• For codes 99446–99449, and 99451 the CPT^® definition specifically says consulting physician, not “or other qualified health care professional”
• Following CPT^® rules, do not bill the above codes for services performed by a nurse practitioner or physician assistant
• Treating physician/NP/PA requests the opinion and/or treatment advice of a physician with specific specialty expertise to assist in diagnosis or management of the patient’s problem without seeing the patient
• May be a new or established patient to the consultant, for a new or existing problem
• Consultant may not have had a face-to-face service with the patient in the last 14 days
• May not bill if review leads to a face-to-face service with the patient in the next 14 days
• Majority of the time must be medical consultative verbal or internet discussion (greater than 50%)
• For 99446, 99447, 99448, 99449, if greater than 50% is in data review and/or analysis, do not bill those codes; according to CPT^®, this doesn’t qualify
• 99451 may be billed if more than 50% of the 5-minute time is data review and/or analysis
• Do not report these codes more than once in a 7-day period
• Do not use for a transfer of care
• Written or verbal request should be documented in the patient’s medical record, including the reason for the consult
• According to CMS, these codes are payable in both a facility and non-facility setting

CPT® Rules – Non-Physician Only (QHP)

• Code 99452 may be reported by a physician, NP, PA
• Use for time of 16-30 minutes in a service day preparing for the referral and/or communicating with the consultant
• May not be reported more than once in a 14-day period
• May report face-to-face prolonged care codes with this service if an E/M service is also provided and the time exceeds 30 minutes beyond the typical time
• If the patient is not present, may report non-face-to-face prolonged codes if the time spent in the day exceeds 30 minutes

FAQ

What is the difference between CPT® codes 99446 and 99451?

Question:

I’ve been trying to figure out what the difference is between CPT^® codes 99446 and 99451.  I finally found this in re-reading your article.  Is this the only difference between these 2 codes?

• For 99446, 99447, 99448, 99449, if greater than 50% is in data review and/or analysis, do not bill those codes; according to CPT^®, this doesn’t qualify
• 99451 may be billed if more than 50% of the 5-minute time is data review and/or analysis

I’m quite certain that I’m going to spend hours trying to make these new codes understandable to the docs, just for them to say it’s too much trouble for too little payment.

Answer:

99446-99449 require verbal and written feedback. Over half of the time must be spent in this verbal/electronic feedback.

“The majority of the service time reported (greater than 50%) must be devoted to the medical consultative verbal or Internet discussion).”

99451 doesn’t require it, and can be billed if more than 50% of the 5 minutes is in data analysis.

That’s what I see as the difference.

References