One of the many changes that went into effect on January 1st is the introduction of new evaluation and management codes. In certain cases, physicians must consult the expertise of other physicians who may have greater knowledge regarding that specialty. In these cases, the consulting physician uses the evaluation and management codes to report a billable service. These situations are non-face-to-face (phone/internet) due to distance or time limitations.
Each code depends on the length of the service:
- 99446: 5-10 minutes
- 99447: 11-20 minutes
- 99448: 21-30 minutes
- 99449: 31+ minutes
Only one code needs to be reported based on how long the consultation takes. This time should include review of patient information, such as medical records, medication profile, and laboratory and imaging studies. The codes shouldn’t be used if the interaction lasts less than five minutes. If multiple calls are required, the service should be treated as a cumulative session when selecting a code.
The consulting physician cannot have seen the patient within 14 days of the consultation and transfer of care cannot occur until afterwards. If the consultant has seen the patient previously, the patient must have new problems or aggravation of an enduring problem. It’s pertinent to ensure that the patient knows of the consultation service before it occurs, as they may not be aware of what they’re being billed for.
Author: Apoorva Anupindi