Oncology & Hematology Coding Alert

Question: In a patient with suspected acute myeloid leukemia, our physician wanted to seek opinion from another colleague. Our physician securely sent the patient information to another physician in e mail for the opinion of this second physician on the condition of the patient. Is there an E/M code that we can use for this consultation?

Colorado Subscriber

Answer: The codes for telephone and internet assessment and management services became available on Jan. 1, 2014. You can use the appropriate CPT® code from the 99446-99449 (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; …) range for the consultation that your physician seeks. 

Confirm time for consultation: When your physician relies on the phone or internet for consults, you have four time-based codes to choose from:

• 99446 — … 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.

These codes come in handy the more physicians lean on the internet or phone conversations for assistance with consultations between themselves and other healthcare professionals and patients.

Keep complete documentation and check with your payers: Since these codes are consultation codes, there has to be a written report provided to the receiving physician in order to support the use of the code, as stated in the code descriptors. Additionally, you will want to check with your payers to see if these codes are covered. Payers may not cover non face-to-face services with the patient. 

If, however, the initiating physician wants the consultant to see the patient, the consultant would almost certainly receive payment. This is because when the patient presents, is seen and evaluated in person, most payers will pay for the face-to-face consultation.