Oncology & Hematology Coding Alert

Question: Our oncologists want to report consult codes 99446-99449 when they are compiling a chemotherapy treatment plan for a patient. The plan is then sent to an oncology pharmacist who weighs in on if they think the course of treatment is appropriate. Is this the correct way to be reporting this service? It seems as though the pharmacist should be reporting the consult code, but the provider is wanting to report a CPT^® code to capture the workload of reviewing the chart and collaboration.

AAPC Forum Participant

Answer: In scenarios such as this, it would be wrong for the oncologist to use 99446 (Interprofessional telephone/Internet/electronic health record 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), or 99449 (… 31 minutes or more of medical consultative discussion and review) (underline for emphasis).

That’s because consultant codes are billed by the consultant — the oncology pharmacist — and not the provider requesting the consult — in this case, your oncologist. (Note: The oncology pharmacist cannot bill 99446-99448 in this scenario either as they are not a physician.)

Do this instead: Depending on specifics, your oncologist could bill 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) for at least 30 minutes of prolonged service time as well as +99359 (… each additional 30 minutes (List separately in addition to code for prolonged service) if the time exceeds the base code’s hour time parameter by at least 15 minutes (minimum of 75 minutes for 1 unit of +99359) and additional units of +99359 for each increment of 30 minutes after the first hour if at least 15 minutes of time is supported (a minimum of 105 minutes for 2 units of +99359).

But before you reach for 99358/+99359, make sure the codes:

• “Relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management” per CPT^® guidelines, and
• Consist of services such as “prolonged communication/ consulting with QHPs related to ongoing management of the patient, extensive record review related to an E/M service performed earlier on the patient, or prolonged review of an extensive health record and diagnostic test results regarding the patient” per CPT^® Assistant Volume 29: Issue 1 (January 2019).

Additionally, even though 99358/+99359 must relate to an E/M service, the codes cannot be used for prolonged non-face-to-face care on the same date of service as office/outpatient evaluation and management E/M services 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …). When prolonged time without direct patient contact is spent on the same date as an office or other outpatient service, you can consider +99417 (Prolonged office or other outpatient evaluation and management service(s) … with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time …) or G2212 (Prolonged office or other outpatient evaluation and management service(s) … each 15 minutes of total time …) for Medicare patients.