Urology Coding Alert

Hint: It centers on which side of the consultation you’re reporting.

With so many CCI edits tying in with codes 99451 and 99452, it’s important to understand these new codes.

According to CPT^® coding guidelines, the provider you’re coding for is acting as a consultant when performing the services of 99451.

In that situation, the urologist accesses the patient’s medical record via telephone, internet, or electronic health record (EHR). The urologist evaluates whatever records are available – history and physical, lab results, imaging reports, surgical reports, etc. The urologist then provides an opinion on the case and sends the referring provider (the treating or requesting physician or other qualified healthcare professional) a written report of treatment/management recommendations.

The difference with the service of 99452 is that you’re reporting for the other side of the equation: the patient’s primary provider rather than the consulting provider. Guidelines state that 99452 represents when a provider (such as the patient’s primary care physician or other qualified health care professional) interacts with a consulting provider via telephone, the internet, or an EHR. The communication is initiated so the primary provider can share information with the consultant to help him or her form an opinion about the patient’s future treatment or care management.

“Referrals of the kind described by 99452 are usually performed by clinical staff in an office, not the provider,” says Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Ind.