Don’t expect to see payment any time soon for ‘telephone consults’

October 15th, 2014 - Scott Kraft
Categories:   Bundling   Coding   CPT® Coding   Evaluation & Management (E/M)  
0 Votes - Sign in to vote or comment.

Four new CPT® codes that got some attention when the 2014 CPT® changes were released late last year were a new E/M code series, 99446-99449, designed to be reported when a consulting provider offered a telephone or Internet E/M service that included a verbal and written report back to the patient’s requesting physician.

The delivery of physician services may be getting close to a technology tipping point – after all, a recent Information Week report suggests even telemedicine will be a $27 billion business by 2016.

But these new codes are likely to be another instances where the technology – and the availability of the codes for billing and tracking – is ahead of the world of payment. So far, Medicare slapped the new codes with a payment status indicator of B – making them bundled into all other services – and there is no evidence that any other payers see them any differently.

It’s unclear whether the time spent on these service could truly be “bundled” into a face-to-face encounter, given Medicare’s refusal to pay for non face-to-face care. At least not yet.

The four codes are based on the amount of time spent on the service, and are intended for use by the provider being consulted. 99446 is for between 5-10 minutes of time, 99447 for 11-20 minutes, 99448 for 21-30 minutes and 99449 for more than 31 minutes.

The time counted toward the services are medical consultative discussion and review time spent by the specialist. These new codes are different from the 99441-99444 set created in 2008 for phone or Internet E/M services with the patient because they are intended to cover discussions between providers.

If a payer allows you to bill these codes, or to consider the time spent as part of a bundle into a different E/M face-to-face encounter, remember these rules that govern their use:
  • Discussions of less than five minutes are not reportable.
  • The patient may be a new or established patient to the specialist, but must not have seen the specialist face-to-face in the previous 14 days or the following 14 days.
  • Discussions initiated to facilitate a known transfer of care may not be counted.
  • If more than one phone conversation is needed, the calls are bundled into a single code for reporting purposes.
  • Like a consult, the request for the specialist’s opinion and the ultimate report back needs to be documented in the patient’s record.
  • These services are intended for urgent or complex cases where a face-to-face visit with the specialist may not be possible.
  • This service should not be reported more than one time per patient over a seven-day period.


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

​​Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association