Don’t Use 94451 for Referring Physician’s Work
Question: A provider in my practice reached out to another physician to consult on a patient’s issue. I billed 99451 but the claim was denied. What should I have billed instead? Texas Subscriber Answer: When you look at the description for 99451 (Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time), you’ll note that the assessment and management service is provided by a consultative physician. So, your claim may have been denied because the physician in your practice was the referring physician, not the consulting physician. Depending on the documentation and services provided, 99452 (Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes) may be a more appropriate evaluation and management (E/M) code to report in this situation, as it covers the initial referral work provided by the “treating/requesting physician.” Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
