Otolaryngology Coding Alert

Remember to include documentation as before – but you still might not get paid.

Medicare and some other insurers stopped recognizing consultation codes a few years ago, but it’s time to take a fresh look at the service. Consultations are not just a thing of the past, thanks to four new codes that will become effective January 1.

CPT® 2014 adds 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 via the internet through secure portals. A lot of health plans and insurance carriers are offering their members access to health records and their healthcare providers or case representatives on-line. These avenues give patients the ability to check their records, confirm what their doctors told them, ask further questions, question potential mis-recorded information, etc. These codes appear to be in recognition of these situations. It affords the physician the ability to forward patient information (securely) to another physician for opinion and insight without having the patient come to all the different appointments.”

Documentation: As in the past, 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.”

Questions: 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 continues. “Will it be documented?”

The biggest question of all: Will payers pay for the services associated with the new codes?

“Just because there is a code doesn’t mean that it’s paid,” reminds Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “It doesn’t mean you don’t use the code – you want to document usage and then write it off if it’s not paid. Then use the statistics of how often the service was provided to fight in future years to get payment from an insurer. It also documents the added value the practice provides to patients when negotiating a contract.”

“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.

Answers: Once the 2014 insurance fee schedules are released, Otolaryngology Coding Alert will share all the information you need for successful filing.