Pulmonology Coding Alert

Question: Our pulmonologist was using an online app to consult with another pulmonologist about the care of a patient who had recovered from COVID-19 but was still having significant lung issues. Our physician had previously treated a case like this so the requesting physician had questions for him about the best way to proceed. They spoke on the phone for 15 minutes about the patient’s care and discussed possible treatment methods. How can we code this service?

Pennsylvania Subscriber

Answer: In some instances, a treating physician may reach out to a more specialized provider within the same specialty, or a provider of a different specialty, to discuss diagnostic and/or treatment management of a patient’s condition. So long as a strict set of criteria are met, both providers can bill for these services in some capacity using codes from the respective E/M subsection.

In your situation, because the pulmonologist consulted with a requesting physician using audiovisual, telephone, or a virtual form of communication, you may report one of the following consultation codes:

• 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)
• 99449 (… 31 minutes or more of medical consultative discussion and review)

Because you mention that the call lasted 15 minutes, 99447 is likely to be the best fit for your claim, depending on the documentation. CPT^®, private payers, and each individual MAC will publish its own guidelines you should adhere to when coding for a consulting provider. For instance, the patient may either be new or established to the consulting provider, but the consulting provider may not bill for the service if they have seen the patient within the past 14 days. The use of code range 99446-99449 should also “conclude with a verbal opinion report and written report from the consultant to the treating/ requesting physician,” according to the CPT^® code book.