EM Coding Alert

Question: Our gastroenterologist consulted with a patient that was referred to her by a pulmonologist. The patient was previously being treated for symptoms of wheezing and asthma. The consultation was for symptoms of gastroesophageal reflux disease (GERD). The pulmonologist’s opinion is that the current symptoms are a complication of the GERD. Our gastroenterologist reviewed the patient’s history, medical records, diagnostic studies, and the present and past medication regime. She then spent 20 minutes over the phone with the pulmonologist discussing observations, interpretations of tests, and further testing and treatment. What can I report?

Nebraska Subscriber

Answer: If there is documentation to support the consultation, such as a letter from the requesting pulmonologist, and your payer still allows consultation codes, you can report this service using 99241-99245 (Office consultation for a new or established patient, …), choosing the level of service based on the documentation.

The time on the phone is usually not billable. There are codes for phone calls, but many payers do not pay for these services. Since your gastroenterologist spent 20 minutes discussing the patient’s condition, you can try to report his services using 99447 (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; …). 

Restrictions: Use these codes for urgent situations of a complex nature where a timely response is needed. Check with your top payers before attempting to use these codes. Do not report this service more than once within a seven-day interval. If you need more than one telephone/Internet contact(s) to complete the consultation request, you should report the whole service and the cumulative discussion and information review time with a single code. If the payer is going to pay you for the 99447 service, they want to see evidence in the documentation fulfilling these requirements.

For example, in the scenario above, if your gastroenterologist spent an additional 10 minutes the next day over the phone with the pulmonologist, you have to report 99449 (...31 minutes or more of medical consultative discussion and review) to cover the 20 minutes spent on the first day and the 10 minutes spent on the second day. Do not report telephone/Internet consultations of less than five minutes.

Pointer: You can account for the time spent in another way if your payer won’t allow 99447. Use the information gleaned from the call toward the decision-making component of the consultation to determine the service level. The gastroenterologist could get two points in the data component of the medical decision-making for gathering history from someone other than the patient. If your physician gathers other information such as past medical issues, family issues, or social history information, you can use this toward the history components if appropriately documented.