Gastroenterology Coding Alert

Hint: Add up time when discussion spans over more than one session.

When your gastroenterologist reviews and discusses a patient’s condition with a referring physician over the phone or via the internet on or after Jan.1, 2014, you can report this service by choosing from four new CPT® codes based on time spent.

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 and each other via the internet through secure email lines, etc. These codes appear to be in recognition of these situations. It affords a physician the ability to provide a virtual consultation to another physician without having the patient come to all the different appointments.”

As noted, 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).

Example: A pulmonologist refers a patient whom he has been treating previously for symptoms of wheezing and asthma to consult with your gastroenterologist for symptoms of gastroesophageal reflux disease (GERD). The pulmonologist is of the opinion that the pulmonary symptoms that the patient is currently experiencing is being caused as a complication of the GERD and needs your gastroenterologist’s opinion.

Your gastroenterologist reviews the patient’s history, medical records (provided by fax/email), diagnostic studies, and the present and past medication regime.

Your clinician then spends 20 minutes over the phone with the pulmonologist discussing the treating physician’s observations and interpretations of tests. He also discusses further testing to check if the pulmonary condition is being caused by the GERD and whether the condition would improve by the treatment of the GERD. .

What to report: Since your gastroenterologist spent 20 minutes discussing the patient’s condition, you can report his services using 99447.

Restrictions: These codes are used for urgent situations of a complex nature where a timely response is needed. “The patient may be new or established to the consultant, but these codes cannot be reported if the consultant has seen the patient in the last 14 days, or accepts an immediate transfer of patient care with subsequent provision of a face-to-face service within the 14 days of the interprofessional consultation,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia. “If the sole purpose of the conversation between the treating physician and the consultant involves transfer of care arrangements, these codes cannot be used.”

This service should not be reported more than once within a seven-day interval. If more than one telephone/Internet contact(s) is needed to complete the consultation request, the whole service and the cumulative discussion and information review time should be reported with a single code. For example, in the above mentioned scenario, if your gastroenterologist spends an additional 10 minutes on the next day over the phone with the pulmonologist, you have to report 99449 to cover the 20 minutes spent on the first day and the 10 minutes spent on the second day. Telephone/Internet consultations of less than five minutes should not be reported.

More questions:Note that these codes are time based codes. So, you’ll have to base your code selection on the amount of time that was spent for the discussion. 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. “What will the reimbursement look like in comparison with having the patient actually come into the office?”

“The physicians will want to know if it is something they might be able to utilize,” says Chandra L. Hines, practice supervisor of Wake Specialty Physicians in Raleigh, NC, who echoes many coders interested in determining whether insurers will include payment for these codes, since they are consultations.

The biggest question involves reimbursement. “As with many of the other non-face-to-face service, separate reimbursement is not permitted, particularly since there is no patient evaluation (remotely or in-person) involved,” reminds Pohlig. “Providers will be anxiously awaiting CMS’ release of the 2014 Physician Fee Schedule to determine the fate of these codes.”

Editor’s note:Keep an eye on Gastroenterology Coding Alert for more on whether these are payable once the 2014 insurance fee schedules are released.