2014 Evaluation and Management Code Changes By Jackie Miller, RHIA, CCS-P, CPC he 2014 CPT® code set includes a number of new and revised codes and coding guidelines for evaluation and management (E/M) services. In this column, we will review the changes related to interprofessional telephone/ Internet consultation, complex chronic care coordination, and transitional care management. Telephone/Internet Consultation Four new codes have been established for interprofessional telephone or Internet consultations: • 99446 – Interprofessional telephone/Internet 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 • 99447 – … 11-20 minutes of medical consultative discussion and review • 99448 – … 21-30 minutes of medical consultative discussion and review • 99449 – … 31 minutes or more of medical consultative discussion and review The pre-existing codes for telephone and online services (99441– 99444) represent non-face-to-face e/m services provided by a physician to one of his or her established patients. The new codes, on the other hand, are used to report a consultation with a patient’s treating physician that is performed via the telephone or Internet. as an example, an internist in a rural area might request a telephone/ Internet consultation with an infectious disease specialist at a large urban medical center regarding a patient with an antibiotic-resistant infection. The patient may be either new or established to the consultant. The consultation must be requested by the patient’s treating physician or practitioner, who needs the consultant’s “specific specialty expertise” to help evaluate and manage the patient’s 32 HBma BIllIng • maRCH.aPRIl.2014 condition. The request must be documented in the medical record. The treating physician provides the consultant with pertinent data about the patient, including history, examination findings, imaging studies, lab test results, etc. The consultant reviews this information and provides the requesting physician with the diagnostic impression and management recommendations. The consultant communicates this information verbally by telephone or real-time Internet connection (i.e., “chat”) and provides a written report that summarizes the verbal discussion. (see “non-Faceto Face services: Interprofessional Telephone/Internet Consultations,” CPT® assistant, October 2013.) Code selection is based on the service time, and the review of test results and other pertinent data either before or after the consultation counts toward that service time. However, the CPT manual states that the majority of the service time (more than 50 percent) “must be devoted to the medical consultative verbal/ Internet discussion.” In other words, the actual conversation between the requesting physician and the consultant must represent more than 50 percent of the time that the consultant bills. The interprofessional consultation codes should not be reported if the consultant has agreed to accept transfer of care before the consultation. However, like the regular consultation codes, the consultant can report the telephone/Internet consult codes if he or she decides to accept transfer of care after the consultation. additionally, these codes should not be assigned if the consultant has seen the patient in a face-to-face encounter within the past 14 days or if the consultation leads to an immediate transfer of care or other face-to-face service within the next 14 days or next available appointment date. Telephone/Internet consultation cannot be reported more than once per seven-day period. If more than one telephone/Internet session is needed during the seven-day period, the sessions should be added together and the consultant should report a single code. Complex Chronic Care Coordination The complex chronic care coordination codes (99487–99489) were added to the CPT code set in 2013, and this year the guide- T
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