Primary Care Coding Alert

Question: Our doctor called a radiologist to discuss an X-ray with him. This took around 10 minutes. Then, the provider called an established patient via video/Skype to discuss the results of the X-ray, which took 15 minutes. Can we bill for these calls given that they are so brief?

Virginia Subscriber

Answer: For the consultation between the radiologist and your provider, you would be able to use a new code, 99452 (Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes) if the amount of time spent met CPT^® guidelines.

Per CPT®  guidelines for the code, and consistent with CPT^®’s general rule about time thresholds, “the treating/requesting physician or other qualified health care professional may report 99452 if spending 16-30 minutes in a service day preparing for the referral and/or communicating with the consultant.” Just make sure you document the length of the call and the time spent preparing for it. If that documentation reflects that the preparation and call together are at least as long as the code’s threshold time of 16 minutes, then you can report the service.

For the patient conference, there are two possible options you could use. One would be 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

Since the code descriptor is not time-based, the length of the conversation is immaterial. But this time, you’ll have to make sure you meet the code’s more stringent CPT^® criteria:

• The patient must be established.
• The service must be in response to a patient’s online inquiry.
• The call cannot refer to an E/M service the physician performed within the previous seven days or within the postoperative period of the previous procedure.
• The service must involve permanent storage (electronic or hard copy) of the encounter.

As you reference a discussion about an X-ray, there is a good possibility that your provider documented an E/M service related to the X-ray. If that service occurred during the previous week, per the third requirement, you probably won’t be able to claim the call, and a payer would regard it as part of the E/M service your provider had already performed.

The alternative is to report the service using an appropriate code from 99212 through 99215 (Office or other outpatient visit for the evaluation and management of an established patient …) as, per CPT^® Appendix P, you can use these codes when they “involve electronic communication using interactive telecommunications equipment that includes, at a minimum, audio and video.” Just remember to append modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to the code you choose from the 99212 through 99215 set.