EM Coding Alert

If you thought 2014 would bring an end to consultation coding confusion, think again.

Rumors have swirled about whether consultation codes would soon be eliminated from the CPT^® manual. For 2014, there are no deletions of E/M codes, even the consult codes. In fact, you’ll find four new consultation-related codes.

Read on to learn about the E/M code changes you need to know before the CPT^® 2014 codes go into effect on Jan. 1, 2014.

Consultations are Not Just a Thing of the Past

Effective Jan. 1, CPT^® will include four new codes that describe the work of two medical professionals who discuss a patient’s condition via phone or internet, as follows:

• 99446 (Interprofessional telephone/Internet 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).

“The interprofessional codes are interesting,” says Suzan Berman, MPM, CPC, CEMC, CEDC, manager of physician compliance auditing for West Penn Allegheny Health Systems, Pittsburgh, Penn. “More and more, the provider community is communicating with patients via the internet through secure email lines, etc. A lot of health plans and insurance carriers are offering their members access to health records and their healthcare providers or case representatives on-line. These avenues give patients the ability to check their records, confirm what their doctors told them, ask further questions, question potential mis-recorded information, etc. These codes appear to be in recognition of these situations. It affords the physician the ability to forward patient information (securely) to another physician for opinion and insight without having the patient come to all the different appointments.”

As in the past, these new codes are consultative in nature, which means you must provide a written report back to the requesting physician to qualify for the code, as indicated by the phrase “including a verbal and written report” (emphasis added).

More questions: Coders and consultants alike have many questions about these new codes. “I am a bit curious about why they are broken into time and how that time will be measured (reading, discussing, interpreting, further research, etc.). How will the time be documented?” Berman asks. “Will it be documented? What will the reimbursement look like in comparison with having the patient actually come into the office? Will Medicare recognize these codes without a face-to-face as is defined in their definition of E/M?”

It isn’t clear yet whether Medicare will include payment for these codes, since they are consultations, but keep an eye on E/M Coding Alert for more on whether these are payable once the 2014 Medicare Physician Fee Schedule is released.

“The physicians will want to know if it something they might be able to utilize,” says Chandra L. Hines, practice supervisor of Wake Specialty Physicians in Raleigh, NC.

99481/99482 Replace Category III Codes

You’ll find two new neonate hypothermia codes among the E/M code changes as well. CPT^® 2014 adds the following:

• +99481 — Total body systemic hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure)
• +99482 — Selective head hypothermia in a critically ill neonate per day (List separately in addition to code for primary procedure).

“These are highly specialized codes and are not used by most pediatricians,” says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.

These new codes seem to replace Category III codes 0260T (Total body systemic hypothermia, per day, in the neonate 28 days of age or younger) and 0261T (Selective head hypothermia, per day, in the neonate 28 days of age or younger), which are deleted in 2014.

Reminder: When a category III code exists to describe a service or procedure, you must use that category III code — rather than an unlisted procedure code — to describe the service when placing a claim. So, why is this so important?

Category III CPT^® codes are temporary codes that describe emerging technology, services, and procedures.

The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy. In other words, category III codes give insurers and government policy makers a way to track the effectiveness and rate-of-use of as-yet-unproven technologies, which could affect future coverage decisions.