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February 5, 2023

Interprofessional Internet Consultations

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CMS recognizes and pays for six codes for interprofessional consults codes 99446–99449, 99451, 99452

These are not considered telehealth services. Why?

  • They aren’t on either CPT’s or CMS’s list of telehealth services
  • They do not use real-time, interactive, audio visual communication with the patient
  • For Medicare, do not use POS 02 or modifier 95; check with other payers
  • Here is an audit tool you can use for these services

Watch this brief video and then read on:

Download slides

Consulting without seeing the patient

These six codes describe assessment and management consultative service provided by phone, internet or electronic health record when the patient’s treating physician/ non-physician practitioner (NPP) requests an opinion and/or treatment advice of a consulting physician/NPP.  The consulting physician/NPP has specific specialty expertise to assist in the diagnosis and/or management of the patient, without a face-to-face visit.

These are all time-based codes.

  • The first five are for use by the consulting clinician.
  • The sixth is for the use of the treating physician, NP or PA.

 

Code Description
99446 Interprofessional telephone/Internet/electronic health 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
99451 Interprofessional telephone/Internet/electronic health assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes of medical consultative discussion and review
99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified health care professional, 30 minutes

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 for reporting interprofessional telephone/Internet Electronic Health Record Consultations by a treating physician or other qualified health care professional

  • 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

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.


 

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Relevant Search Terms: Can an NP/PA bill for interprofessional consults, Billing for interprofessional consults, 99446, 99451, 99452

Last revised May 10, 2022 - Betsy Nicoletti
Tags: telehealth

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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