Coding and Billing

Coding for Telehealth Consultations

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

March 6, 2019

The final 2019 Medicare Physician Fee Schedule contains four existing CPT codes (99446-99449), and creates two new CPT codes (99451 and 99452) for Interprofessional Internet Consultations.

Specifically, the codes are for assessment and management services conducted through telephone, internet, or electronic health record consultations, furnished when a patient’s treating physician requests the advice of a consulting physician with specific specialty expertise to assist with the diagnosis, treatment and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consulting physician.

This change increases efficiency for patients and providers by eliminating the need for separate (and often costly and inconvenient) specialist appointments in cases where a phone or internet-based interaction between the treating physician and the consulting physician is enough.

The final code descriptors for Interprofessional Internet Consultations are as follows:

CPT 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.

CPT 99447: Same as 99446, but 11-20 minutes of medical consultative discussion and review.

CPT 99448: Same as 99446, but 21-30 minutes of medical consultative discussion and review.

CPT 99449: Same as 99446, but 31 minutes or more of medical consultative discussion and review.

CPT 99451: Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified health-care professional, five or more minutes of medical consultative time.

CPT 99452: Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health-care professional, 30 minutes.

Here’s what you need to know about using these codes and billing for Interprofessional Internet Consultations:

Billing Practitioner. CPT code 99452 applies to the treating/referring physician. The rest of the codes apply to the consultative physician.

Consent. Verbal patient consent must be documented in the patient’s medical record for each consultation. The patient’s consent must include assurance that the patient is aware of applicable cost-sharing fees.

Cost Sharing. Providers must collect the requisite co-payment from the patient for each service billed. (This is true for all Medicare Part B services.)

Benefit of the Patient. The consultation must be undertaken for the benefit of the patient, not for the education of the doctor asking for the consultation, nor as a professional courtesy.

HIPPA Compliance. You must make sure you are utilizing a HIPAA-secure communications platform for these communications.

 

References
i. CPT® copyright 2019, American Medical Association.
ii. https://www.nixonlawgroup.com/nlg-blog/reimbursement-interprofessional-internet-consultations-new-cpt-codes

To Top
  
Subscribe Today Free...
And join more than 25,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
YOUR EMAIL
FIRST NAME
LAST NAME
  
Subscribe Today Free...
And join more than 25,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
YOUR EMAIL
FIRST NAME
LAST NAME
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.