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)  
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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.

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