Interprofessional Consultations: What You Should Know

One may consider the following CPT codes when there is communication between a consulting physician and a referring provider.

CPT^® 99446 - Interprofessional telephone/Internet/electronic health record 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

CPT 99447 - Interprofessional telephone/Internet/electronic health record 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; 11-20 minutes of medical consultative discussion and review

CPT 99448 - Interprofessional telephone/Internet/electronic health record 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; 21-30 minutes of medical consultative discussion and review

CPT 99449 - Interprofessional telephone/Internet/electronic health record 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; 31 minutes or more of medical consultative discussion and review

CPT 99451 - Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, 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

A consulting physician may submit these CPT codes if the consulting physician is contacted by a referring provider via telephone, Internet communication, or through electronic health record communication and the consulting physician discusses the case with the referring provider and sends a written report to the referring provider regarding this discussion and the consulting physician documents the event. The consulting physician needs to provide some form of “management” during the consultation in order to use these CPT codes. Only a physician can use CPT 99446 – 99451.

The difference between CPT 99446-99449 and CPT 99451 is CPT 99446-99449 requires the consulting physician to provide a verbal opinion and written report to the referring provider and CPT 99451 only requires the consulting provider to provide a written report to the referring provider.

These CPT codes can only be used by the consulting physician if the consulting physician and referring provider are different provider types. These CPT codes may not be used by the consulting physician if the consulting physician had a face-to-face encounter with the patient in the last 14 days or the consultation leads to the patient having a face-to-face service with the consulting physician in the next 14 days. These CPT codes may also not be used by the consulting physician if the consultation leads to a transfer of care from the referring provider to the consulting physician. When using these CPT codes, the majority of the service time reported (greater than 50 percent) must be devoted to the medical consultative verbal or Internet discussion. The service must last 5 minutes or more in order to use the above listed CPT codes.

There is another CPT code in the “Interprofessional Telephone/Internet/Electronic Health Record Consultations” section of CPT:

CPT 99452 - "Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified health care professional, 30 minutes"

This CPT code may be used by the provider requesting the consultation of a physician of another specialty. In order to use this code, the requesting provider must spend between 16 and 30 minutes preparing for the referral and/or communicating with the consultant. This preparing could include gathering of documents/patient information, transmitting them to the consultant, and drafting and sending additional communication to the consultant regarding the request. This time may also include interactive communication with the consultant, like a phone call. This CPT code may not be reported more than once in a 14-day period for the same patient. This may not be used for a transfer of care, so it can be used when requesting input from a consultant, but cannot be used when transferring care of the patient to a consultant. When submitted, it is important to document exactly what was performed, all the steps of information sharing and communication, and how much time was spent. CPT 99452 cannot be submitted the same day as an in-person evaluation and management service.

Dr. Lehrman operates Lehrman Consulting, LLC, is a consultant to the APMA Health Policy and Practice Department, serves as an expert panelist on Codingline, and is a Certified Professional Coder. Follow him on Twitter @DrLehrman

Reference

1. AMA CPT Editorial Panel. CPT 2021 Professional Edition Current Procedural Terminology (CPT®) American Medical Association.