Neurology & Pain Management Coding Alert

Heads up: It could be time to refresh your consultation coding knowledge.

New codes for chemodenervation procedures might be top of mind for 2014, as discussed in the last issue of Neurology and Pain Management Coding Alert. But don’t skip past the E/M section when checking out new codes, however, because you’ll also find a welcome addition there – four codes related to interprofessional consultations.

Check Out New Phone/Internet Codes

It’s not uncommon for your physicians to discuss a patient’s condition with another medical professional via phone or internet, such as when they’re discussing pain management strategies or the patient’s suitability for surgery. So, beginning Jan.1, 2014, look for four new codes using the code range 9944X to describe this work, depending on the time spent on the service:

• 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.

Caveat: “These new codes are intended to be used only by the consultant physician,” says Kent Moore, senior manager for physician payment at the American Academy of Family Physicians. “The patient’s treating physician, which is typically the attending or primary care physician, who is seeking the consultant’s opinion or advice with respect to diagnosis and/or management of the patient will not be able to use these codes for his or her portion of the conversation. That said, if one physician is consulted by another physician or other qualified health care professional in this way, there is nothing to preclude the first physician from reporting these codes.”

Get the Scoop on Expert Usage

“The interprofessional codes are interesting,” says Suzan Berman, MPM, CPC, CEMC, CEDC, manager of physician compliance auditing for West Penn Allegheny Health Systems in Pittsburgh, Penn. “More and more, the provider community is communicating with patients via the internet through secure email lines, etc. A lot of health plans and insurance carriers are offering their members access to health records and their healthcare providers or case representatives on-line. These avenues give patients the ability to check their records, confirm what their doctors told them, ask further questions, question potential mis-recorded information, etc. These codes appear to be in recognition of these situations. It affords the physician the ability to forward patient information (securely) to another physician for opinion and insight without having the patient come to all the different appointments.”

Documentation: As in the past, these new codes are consultative in nature, which means you must provide a written report back to the requesting physician to qualify for the code, as indicated by the phrase “including a verbal and written report” (emphasis added).

Questions: Coders and consultants alike have many questions about these new codes. “I am a bit curious about why they are broken into time,” Berman says. “How will the time be documented? Will it be documented? What will the reimbursement look like in comparison with having the patient actually come into the office?”

“The physicians will want to know if it is something they might be able to utilize,” says Chandra L. Hines, practice supervisor of Wake Specialty Physicians in Raleigh, N.C., who echoes many coders interested in determining whether insurers will include payment for these codes, since they are consultations.

Reminder: Once the 2014 insurance fee schedules are released, Neurology and Pain Management Coding Alert will share all the information you need for successful filing.