Urology Coding Alert

New codes don’t always mean new payment.

If you were excited about the CPT® addition of new interprofessional telephone/internet consultation codes, you may be sorely disappointed now. Unfortunately, the finalized 2014 Medicare Physician Fee Schedule does not include any relative value units (RVUs) or fees for these new service codes.

While many practices suspected that they wouldn’t see payment for these codes, CMS’s latest confirmation of that fact has left many practitioners disappointed. Here’s what you need to know to make sure you don’t face a bunch of zero dollar claims.

Check Individual Payer Policies

The following new interprofessional telephone/internet consultation codes, that describe the work of two medical professionals who discuss a patient’s condition via phone or Internet, went into effect on Jan. 1:

• 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.
  

That means you can technically start billing these codes if your urologist meets the criteria for them and documents the time spent, since 99446-99449 are time-based codes. However, chances are strong that you won’t collect any reimbursement for these codes.

CMS did not assign any RVUs or fees to this code set for 2014, and most Medicaid providers don’t reimburse for these services either. Some private payers might, but even they are quite restrictive in paying these codes.

For example, CareFirst, a Blue Cross Blue Shield provider, states in its Policies and Procedures, “CareFirst does not provide benefits for non-face-to-face services via telephone or internet; or effective 1/1/2014, interprofessional telephone/internet consultations (99446-99449). All of these services are considered ‘integral to/include in’ all other services, whether reported alone or in addition to other services or procedures.”

Therefore, check with your insurer before billing these codes, and if the representatives tell you that these services are payable, get the policies in writing.