E/M Change: Internet Consultations

Codes For the Consulting Provider: Inter-professional Internet Consultation

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: 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; 11–20 minutes of medical consultative discussion and review.

99448: 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; 21–30 minutes of medical consultative discussion and review.

99449: 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; 31 minutes or more of medical consultative discussion and review.

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 healthcare professional, five or more minutes of medical consultative time.

Code For the Requesting Provider:

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

99446, 99447,99448, 99449,99451:

• Payable only to providers who are permitted to bill E/M services.
• For use by the consulting physician who is providing an opinion, as requested, based on information obtained via telephone, Internet or electronic health record(s).
• Codes do not include any element of F2F service to the patient—these are “provider-to-provider” services.
• Not payable on the same DOS as F2F E/M services (i.e., 99201–99205, 99211–99215, 99221–99223, 99231–99233).
• May be reported before a transfer of care has been accepted by the consulting provider; may not be reported within 14 days after the transfer of care is effectual.
• May be reported by the consultant for patients who are either new or established, when the established patient has a new problem or exacerbation of a previously known problem.
• Codes are not reportable if the consultant has performed a F2F encounter with the patient in the prior 14 days.
• If more than one telephone/Internet contact is needed to complete the consult, service should be reported using only one code, reflecting the cumulative time spent.

99446, 99447, 99448, 99449:

• Codes are not reportable when the purpose of a telephone/Internet communication is to arrange a transfer of care or other F2F service.
• Time-based codes which include both a verbal and written report to the requesting provider
• Require time documentation.

99451:

• Time-based code, requiring five or more minutes of consultative time.
• Time includes only a written report to the requesting provider.
• Requires time documentation.

99452:

• For use by the original treating provider who is requesting the consultation.
• Requires documentation of at least 15 minutes of time spent in discussion and information-sharing with the consulting provider.
• If time spent on this service exceeds 30 minutes, and meets criteria for non-F2F prolonged service, CPTs 99358–99359 may be added to the claims as appropriate to time spent.
• Patient’s verbal consent must be documented in the record for each service; cost-sharing applies.
• Payable only to providers who are permitted to bill E/M services.
• Requesting provider maintains documentation of initial contact and discussion with consultant.
• Consulting/billing provider maintains documentation of requesting provider, topic and summary of recommendation.