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[Kathy Perry]

for Physician to Physician consult code without patient face to face. Method is telephone. A Ednocrinologists receives a call from a PCP asking advice for Insulin adjustment for a hospitalized patient. The call lasted approximatly 30 minutes. The endocrinologists wants to bill for her time. How is this coded?

 

[tcooper@nmhs.net]

I have not used these codes. This is what I found on it. Hope this helps.

An interprofessional telephone/internet consultation (ITC) is defined as an assessment and management service in which a patient’s treating (e.g., attending or primary) physician/other qualified health care professional (QHP) requests the opinion and/or treatment advice of a consultant with specific specialty expertise to assist the treating physician/QHP in the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consultant.
Since the type or severity of the problem is not defined, any condition may qualify for consultative services. However, the codes typically are reported when a new problem arises or a chronic issue is not well-managed or exacerbates.
Only the consultant can report these codes. In addition, these codes require both a verbal and written follow-up report.
Some changes are in store for ITC this year. The American Medical Association Digital Medicine Payment Advisory Group developed two new ITC codes:

• Code 99451 is reported by the consultant, allowing him/her to access data/information through the electronic health record (EHR), in addition to telephone or internet.
• Code 99452 is reported by the requesting/treating physician/QHP (e.g., the primary care physician).

The table outlines distinctions between consultant codes 99446-99449 and the new consultant code 99451 as well as distinct features of code 99452.
Consultant codes99446-99449 and 99451:

• can be reported for new or established patients
• can be reported for a new or exacerbated problem
• are reported only by a consultant when requested by another physician/QHP
• cannot be reported more than once per seven days for the same patient
• are reported based on cumulative time spent, even if that time occurs on subsequent days
• are not reported if a transfer of care or request for a face-to-face consult occurs as a result of the consultation within the next 14 days
• are not reported if the patient was seen by the consultant within the past 14 days
• require that the request and the reason for the request for the consult be documented in the record
• require verbal consent for the interprofessional consultation from the patient/family documented in the patient’s medical record

Requesting/treating physician/QHP code 99452:

• is reported by the physician/QHP who is treating the patient and requesting the non-face-to-face consult for medical advice or opinion — and not for a transfer of care or a face-to-face consult
• is reported only when the patient is not on-site and with the physician/QHP at the time of the consultation
• cannot be reported more than once per 14 days per patient
• includes time preparing for the referral and/or communicating with the consultant
• requires a minimum of 16 minutes
• can be reported with prolonged services, non-direct