Do PCPs, hospitalists, other physicians or NPs/PAs reach out to you for treatment advice for their patients via telephone, internet or EHR? If not, this could be an area of expansion for your practice. You can bill for these interprofessional consults using codes 99446, 99447, 99448, 99449 and 99451. Medicare began paying for these codes in 2019 and commercial payers have begun covering them; check with your commercial payers to determine coverage.
An interprofessional telephone/internet/EHR consultation is an assessment and management service in which a patient’s treating provider requests the opinion and/or treatment advice of a physician with specific specialty expertise to assist them in the diagnosis and/or management of the patient’s problem without patient face-to-face contact with the consultant. Here are the details:
- Only a physician may provide the consulting services provided by these codes.
- The patient can be a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem.
- The consultant cannot have seen the patient in a face-to-face visit within the last 14 days.
- If the consultation results in a transfer of care or a face-to-face encounter within the next 14 days, you can’t bill these codes.
- These codes cannot be reported more than once within a seven-day period.
- For Medicare, the patient or family must give verbal consent for the consult, and it should be documented in the medical record. Check with commercial payers about their requirements regarding patient consent.
- Medicare payments for these codes range from about $18 to about $73.
Codes 99446-99449 have specific requirements:
- More than 50% of the service time reported must be for verbal or internet discussion (vs. data review).
- Both a verbal opinion report and written report from the consultant to the requesting provider are required.
- 99446: reported by the consulting physician for 5 – 10 minutes of consultative discussion/review
- 99447: 11 – 20 minutes
- 99448: 21 – 30 minutes
- 99449: 31 minutes or more
Code 99451 is reported by the consultant for five minutes or more but does not require more than 50% of that time be consultative time as opposed to data review. Furthermore, only a written report is required.
The requesting provider can also bill for these consults. Code 99452 is billed by the treating/requesting provider for time spent in preparing the consult and/or time communicating with the consultant for 16 minutes or more.
For more coding advice for allergists, check out the College’s Coding Toolkit. Our coding FAQs have answers to your coding questions!