Primary Care Coding Alert

Know how to code behind-the-scenes communication between providers.

Providers often need to communicate with one another outside of face-to-face patient appointments, whether by seeking advice from a specialist or checking lab results ordered by another provider.

There are a few different types of codes used for these behind-the-scenes services, and understanding the differences between them can help you make sure you’re coding as accurately as possible. The services discussed in this article are reported by physicians and other qualified healthcare professionals who can independently report evaluation and management (E/M) services.

Look to These Codes for Interprofessional Consults

When a provider seeks the advice of another provider via phone, internet, or electronic health record (EHR), you’ll use 99446 (Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, 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) through 99449 (… 31 minutes or more of medical consultative discussion and review), as appropriate.

To assign these codes, medical consultative discussion must account for more than 50 percent of the total service time. The consulting provider should not have seen the patient in a face-to-face encounter within the previous 14 days, and the consultation should not result in a transfer of care or face-to-face service with the consultant within the next 14 days or at the next available appointment.

Only use these codes once every seven-day period, assigning the same code even if contact was required more than once within that period. You’ll need to report how much time was spent on interprofessional consultations within that period as follows:

• 99446  
• 99447 (… 11-20 minutes of medical consultative discussion and review)
• 99448 (… 21-30 minutes of medical consultative discussion and review)
• 99449

Do not report consultations that lasted fewer than five minutes.

When assigning these codes, document the exact time taken and how much of that time was spent on active communication, as well as the reason for the consult. Consultations using these codes must also conclude with both a verbal opinion report and formal written report.

Code for Review of Records Without a Patient Encounter

When providers share information about a patient without direct verbal communication or face-to-face visits with the patient, you’ll assign 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) or 99452 (Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes). You generally would not report these codes when the interprofessional consultation results in a transfer of care or a face-to-face service with the consultant within the next 14 days or at the next available appointment.

Use 99451 to bill for services performed by the consulting provider who reviews patient data. You can assign this code for services taking five or more minutes and can only be used once within each seven-day period. A written or electronic report is required, and you’ll need to document the reason for the consult and the report.

Use 99452 for services performed by the requesting provider, including time spent preparing a request, gathering records, and communicating with the consulting provider. This code covers 16 to 30 minutes of time from within a single day and cannot be reported more than once every 14 days per patient. When using this code, document the reason for requesting the consulting provider’s opinion.

Code for Review of Records With a Patient Encounter

When a provider reviews notes from another provider as part of a face-to-face visit with a patient, this contributes to the overall evaluation and management (E/M) complexity as part of the medical decision making (MDM) level. Report each external provider as one element under “Review of prior external note(s) from each unique source,” with multiple test results or notes from a single provider counted as a single source. You’ll also need to include the name of the external provider and what was reviewed, as well as how this fits into the patient’s overall management to show why it’s clinically relevant.

Billing for time providers spend consulting other providers outside of face-to-face appointments with patients can be confusing, particularly because you need to be aware of the requirements for the time these services must be performed for.

To confidently report these interprofessional services, keep a few key points in mind:

• 99446-99449: For interprofessional consultations when more than 50 percent of total time is devoted to medical consultative discussion and review, reported once per seven-day period, and not when the consultation results in transfer of care or a face-to-face service with the consultant
• 99451-99452: For interprofessional consultation services that primarily involve review of records and exchange of information, with 99451 reported by the consulting provider and 99452 reported by the treating/requesting provider
• MDM, review of prior external note(s) from each unique source: Such elements of consultation services contribute to overall E/M complexity when time is spent reviewing notes from another provider as part of a face-to-face patient encounter.

Zoe Cunniffe, Health and Medical Writer