Wiki Billing for Referrals?? 99452

[SHobbs]

I have a provider that just opened a new practice. They want to bill 99452 for the office manager referring patients out to specialists. CPT clearly defines physician or other qualified healthcare professional. I am not sure where they received the guidance to bill for this but I would love any feedback here as I know I am going to be met with the amount of time the office manager spends coordinating the referrals.

 

[jkyles]

I have a provider that just opened a new practice. They want to bill 99452 for the office manager referring patients out to specialists. CPT clearly defines physician or other qualified healthcare professional. I am not sure where they received the guidance to bill for this but I would love any feedback here as I know I am going to be met with the amount of time the office manager spends coordinating the referrals.

The work the office manager does is included in the practice expense for the E/M visit. In addition to specifying who can perform the service and that it is between professionals, the CPT manual also explains the work involved and it is more than just referring patients. You might also try sharing this vignette from the CPT Assistant 6/2019:

The intraservice period includes physician work reviewing records, assembling pertinent materials, developing clinical questions/concerns, and transmitting this information to the appropriate consultant. As needed, the treating/requesting physician directly communicates with the consultant.