By: Mary L. Horkey, RCCIR, RCC, MSN-ARC
MSN Senior Coding Manager
Is it true radiologists can now bill for “hallway consults?” Yes, but as usual there are specific documentation requirements and services cannot be billed without documentation of the total time spent on the consultation.
What are those requirements?
- There must be a documented consultation request from the patient’s treating provider in the patient’s medical record. In the event the consulting provider is unable to enter this information into the facility electronic medical record (EMR), the request can be included in the dictated report.
- Codes can be used for both new patients or established patients with a new problem or exacerbation of an existing problem.
- The consultant cannot have seen the patient within the previous 14 days.
- The code cannot be used to transfer care from one provider to another.
- These services can only be reported once in any seven (7) day period.
- Codes include the review of any and all pertinent medical records.
- A dictated report must be produced for inclusion in the patient’s medical record, including the following:
- The reason for the request by the requesting physician.
- The specific content of all verbal/internet discussion for the 9944x codes. (Not required for 99451 and 99452)
- Recommendations for possible treatment or other management options.
- The total amount of service time spent on the consultation, including things such as the review of all pertinent medical records for the patient. Services cannot be billed without documentation of the total time spent on the consultation.
- A CPT code will be assigned based on the total time spent.
- For 99451, the report must document the minimum 5-minute threshold was met.
- Greater than 50% of the total service time must be devoted to the medical discussion (verbal/Internet) for CPT codes 99446, 99447, 99448, 99449
- If the verbal/Internet time is less than 50% of the total service time, a CPT code representing the service will be calculated based on the documented verbal/Internet discussion time and not the total service time.
- The MSN Digital Library provides examples of coding variations when less than 50% of the total service time is spent on the verbal/Internet time. Topic: Interprofessional Consult Services.
CPT® Codes for Interprofessional Consults
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 (0.35 Work RVU). The minimum threshold of 5 minutes must be documented in the report to support this code.
- 99447 – … 11-20 minutes (0.70 Work RVU)
- 99448 – … 21-30 minutes (1.05 Work RVU)
- 99449 – … 31+ minutes (1.40 Work RVU)
- 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 (0.70Work RVU) The minimum threshold of 5 minutes must be documented in the report to support this code.
- 99452- Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes (0.70Work RVU)
Mary Horkey
RCCIR, RCC, MSN-ARC
MSN Senior Coding Manager
Mary Horkey is a Radiology Certified Coder in Interventional Radiology (RCCIR) and a Radiology Certified Coder (RCC). She is a Senior Coding Manager with MSN Healthcare Solutions, with a special emphasis in education and training.
