Wiki Interprofessional consult (99446-99451) once every 7 days

[SUEV]

When a provider is asked to review records twice on the same patient within 7 days, is there any way to charge for the second service? For example:

*On day one the consultant discusses the case with the requesting provider and completes her report. This takes 40 minutes and she charges 99449.
*On day five the patient's condition deteriorates so the consultant is again asked to review records and discusses it with the requesting provider and completes her report. Per CPT, 99446-99449 can only be reported once in a seven-day interval. Does this new
request start the clock over or is this service included in the initial consult?

Thank you,
Sue

 

[SharonCollachi]

You should not be billing them until the 7-day period is up. You add up all the time for 7 days and then bill it. Then the clock restarts.

 

[ciarawetherell@gmail.com]

What if the consult (CPT 99449) is a different provider within the same billing area? Can we use that code within a 7 day interval, then?

 

[SharonCollachi]

What if the consult (CPT 99449) is a different provider within the same billing area? Can we use that code within a 7 day interval, then?

A provider that is not part of your group has nothing to do with your coding/billing in this case.

 

[ciarawetherell@gmail.com]

A provider that is not part of your group has nothing to do with your coding/billing in this case.

So, if I bill/code for both providers, and they're in the same billing area ie. same specialty within the hospital, it doesn't matter? I cannot use that code twice within 7 days, period? What if they were in different billing areas ie. dermatology, cardiology?

 

[SharonCollachi]

Do they work for the same company? If they don't work for the same company, they are each free to provide those services and bill for them.

 

[ciarawetherell@gmail.com]

Yes, same company, same specialty. Do you know where I can find the guidelines, besides the CPT manual about this?
I'm really confused if the doctors are from different specialties, they should be able to bill within a 7 day interval, because they're treating different things, right?

 

[SharonCollachi]

Different specialties do not have to combine their work and bill as one person. But you said "same specialty" in the first sentence, so they do combine their work.

 

[ciarawetherell@gmail.com]

Different specialties do not have to combine their work and bill as one person. But you said "same specialty" in the first sentence, so they do combine their work.

So, you CAN code 99449 more than once in 7 days for different specialties....same patient.