Non Face to Face

ehopper

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Hi-My doc does a lot of Preoperative Cardiac Risk Assessments. He doesn't necessarily have to see the patients face to face, but he does do a thorough review of the chart along with testing and he will dictate a very detailed note. Can we bill this service as a non-face to face? This is not a TCM or CCM but can we bill the 99446-99449 or 99451-99452?
 

TThivierge

Guru
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Lithonia, GA
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Telephone on Online Consult CPT 99441 - 99449

Hello

Yes you can use this but need to do the following. with CPT 99441 to 99446.....
*Physician should document this patient request first on phone conversation or online in med record before he does this service
*He should have seen patient as est patient first
*He should discuss test results, check on meds or discuss new problem related to checking up on chronic problem
*And if transferring care he cannot bill it
* Discussion must be longer than 5 minutes and document properly incase payer wants the med record as proof with claim

I hope this data helps you

Lady T
 

mitchellde

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Columbia, MO
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CPT code 99441-99444 must be established patients and the calls must be initiated by the patient. The encounter you describe would not be one initiated by the patient. Codes 99446-99449 and 99451-99452 are interprofessional phone calls which would your provider speaking to another provider regarding the same patient via telephone. That does not sound like the rendered service either. So about the only code available is 99358-99359 for prolonged non face to face as long as time spent is documented and it exceeds 30 min.
 

mallen

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If a provider sees a patient in office and performs a 25 minute 99214 OV. If he decides during that visit to consult with a specialist and communicates with the specialist about the patient, how should he bill. 99214 and 99452 can't be billed together. The guidelines for 99452 say that the code can be billed with a prolonged care (99354) code if more than 30 minutes is spent on the consult. Do i bill the 99452 and 99354? What should I bill?
 

Pathos

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Beaverton OR
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If the provider consults with another provider/specialist, then that service is considered bundled within the E/M. There might be another "point" gained towards the "Amount of Data" in the MDM section of the E/M visit, if documentation supports this provider to provider communication.

However, based on your example, I do not see any justification for a Prolonged Visit, or a separate code, since the consultation with another provider is part of the E/M.

CMS Prolonged Services
 
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