General Surgery Coding Alert

Question: Our surgeon examined a patient in the office and sent a report about the patient’s condition to a provider who requested it. Should we bill an office evaluation and management (E/M) or a consult (99451 or 99452) or both?

Louisiana Subscriber

Answer: If your surgeon provides information about the patient to another provider who requested a consult from your provider, you should report only a consult E/M code (unless the payer is Medicare), not an office E/M code.

If the surgeon documents a consult, you should not bill 99452 (Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes). As its descriptor indicates, 99452 describes a service provided by the requesting physician or other qualified healthcare professional — the other provider in your situation.

You also would not use 99451 (Interprofessional telephone/ Internet/electronic health record 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 or more of medical consultative time). CPT^® guidelines preceding codes 99451 and 99452 state that providers must conduct these interprofessional telephone/Internet/electronic health record (EHR) consultations “without patient face-to-face contact with the consultant,” but you imply that the service involved face-to-face contact.

Per CPT^®, assuming the necessary conditions were met (such as a documented request by the other provider and a written report prepared for that provider), you would report the appropriate consultation code reflecting the level of service provided. For outpatient consultations, you would report from among codes 99241-99245 (Office consultation for a new or established patient …).

However, some payers, such as Medicare, no longer recognize CPT^® consultation codes and require physicians and other qualified healthcare professionals to report a different E/M code reflecting the appropriate site of service. So, you should check with your payer to see if you may need to report an appropriate office/outpatient E/M code from among 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) rather than a code from among 99241-99245.