Oncology & Hematology Coding Alert

When reporting 99446-99449, focus on time spent and ensure both verbal and written reports.

Starting Jan. 1, 2014 you will have to choose from four new codes when you are reporting for two medical professionals who discuss a patient’s condition by phone or internet. The guide to the most appropriate code is the amount of time the medical professionals spend on the discussion and review.

As shown below, the codes differ based on the amount of time involved:

• 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, Pa. The codes give a provider “the ability to forward patient information (securely) to another physician for opinion and insight without having the patient come to all the different appointments.” The consultant uses 99446-99449 to report the service.

According to CPT® 2014 guidelines, you’re most likely to use the codes for complex or urgent cases where the situation makes it difficult for the consultant to provide a face-to-face service. For instance, the consultant may be located far away.

Tackle Questions about Time

Coders also need to be alert to why these codes “are broken into time and how that time will be measured (reading, discussing, interpreting, further research, etc.). How will the time be documented?” Berman says.

New guidelines instruct that:

• Consultations of less than 5 minutes should not be reported using these codes
• “The majority of the service time reported (greater than 50%) must be devoted to the medical consultative verbal/Internet discussion”
• Review of related medical records, path/lab studies, imaging, medications, and similar data is included in the consult
• A single code covers all contact time and review time, so add together and calculate the total time spent when multiple calls/internet contacts are performed for a single consult.

Don’t miss: The requesting provider should be sure to note the time involved, too. If requirements are met, the requesting provider may be able to use an indirect contact prolonged service E/M code in addition to the appropriate E/M visit code for the patient.

Learn the Limitations before Reporting These Codes

Because these are consult codes, you’ll recognize some familiar issues you have to watch for: transfer of care and documentation of request and report.

When you see that transfer of care has occurred or that the patient has seen or will see the consulting physician, be sure to check these rules before reporting 99446-99449:

• Do NOT report the codes if the consultant agrees to transfer of care before the assessment.
• Reporting the codes may be OK in cases where the physician couldn’t decide on transfer of care until after the consult.
• The patient may be new to the consultant or may be an established patient with either a new problem or an exacerbation.
• If the consultant saw the patient in the last 14 days, do NOT report the codes.
• If the consult leads to immediate transfer of care or another face-to-face service “within the next 14 days or next available appointment date of the consultant,” do NOT use the codes.

You also need to be sure the request/report requirements for the codes are met:

• The request may be verbal or written, but the request, including the reason for it, must be documented in the patient’s medical record.
• Documentation also must include “a verbal opinion report and written report” from the consultant to the requesting provider, guidelines state.

Stay Tuned for Payment News

Berman also notes that reimbursement questions are weighing on many coders minds: “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?”

“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.

Editor’s note: It isn’t clear yet whether Medicare will include payment for these codes, but keep an eye on Oncology & Hematology Coding Alert for more on whether these are payable once the 2014 Medicare Physician Fee Schedule is final.