How to report interprofessional telephone/internet/electronic health record consultations (2024)

Home Practice Reimbursement CPT and Diagnostic Codes

Date created: February 23, 2023 11 min read

  • Technology and Mental Health
  • Managed Care and Insurance
  • Telehealth

Cite This Article

American Psychological Association. (2023, February 23). How to report interprofessional telephone/internet/electronic health record consultations. https://www.apaservices.org/practice/reimbursement/health-codes/interprofessional-record-health-consultations


How to report interprofessional telephone/internet/electronic health record consultations (1)

Psychologists now have a mechanism to provide and report interprofessional telephone/internet/electronic health record consultations. In these consultations, psychologists and other providers may use phone, written, or internet communications to ask other health care professionals for advice in diagnosing and treating their patient’s condition. Face-to-face engagement with a patient is not required.

Effective in January 2023, CPT® codes 99446–99449 and 99451 have been revised to include “other qualified health care professionals” in the code descriptors, guidelines, and instructional parenthetical language, where previously it had only specified “physician.” These revisions were made to provide clarity on the types of providers who are eligible to report these services.

Why are interprofessional consultation services important?

There is an unprecedented growing mental health crisis among all ages across the country. One in five adults experience a diagnosable mental health disorder and two out of five report symptoms of anxiety and depression (NAMI, June 2022). It is critical that those who struggle with mental health problems receive medically necessary care; however, less than half of those who need care are receiving the help they need. Timely access to mental and behavioral health services is often limited by resources, especially in rural and underserved, uninsured, and ethnically diverse patient populations.

Interprofessional consultation services offer several key benefits, including timely access to mental and behavioral specialty care, decreased need for in-person referral or visit, shortened wait times, and an opportunity to support providers in a team-based approach to care. Non-face-to-face consultations are a way to get patients rapid access to specialty psychology expertise that benefits both the patient and the provider.

What are interprofessional consultation services?

Interprofessional telephone/internet/electronic health record consultations are assessment and management services in which “a patient’s treating (e.g., attending or primary) physician or other qualified health care professional (QHP) requests the opinion and/or treatment advice of a physician or other QHP with specific specialty expertise (the consultant) to assist in the diagnosis and/or management of the patient’s problem without patient face-to-face contact with the consultant” (2023 CPT Manual, p. 59).

Codes (99446–99451) are reported by consulting providers who communicate with, and provide expert advice to, treating providers regarding a diagnosis or management of a patient’s problem. These services do not include face-to-face interaction with the patient. Consultation services can be provided to either a new patient, or an established patient with a new problem or an exacerbation of an existing condition. Because the type and/or severity of the problem is not specifically defined, any condition may qualify for consultative services; however, the codes are typically reported when a patient presents with a new problem or when an existing condition is exacerbated or not well managed.

Core components of interprofessional consultation services

There are two types of interprofessional consultation services via communications technology.

Consultation Services with Discussion, Verbal and Written Report Required (CPT codes 99446, 99447, 99448, 99449)

Psychologists can report CPT codes 99446–99449 if more than half of total/cumulative service time is devoted to the consultative verbal or internet discussion with the treating/requesting provider. If greater than 50% of the time for the service is devoted to data review and/or analysis, CPT codes 99446–99449 should not be reported. Additionally, the service concludes with the consulting psychologist providing both a verbal opinion report and a written report to the treating/requesting provider.

Consultation Services without Discussion, Only Written Report Required (CPT code 99451)

CPT code 99451 is reported for the total time spent by the consulting psychologist to access data/information via the electronic health record (EHR), telephone, or internet, performing data review and/or analysis, and interprofessional communication. While a verbal opinion report is not a required component when reporting code 99451, the psychologist must provide a written report to the treating/requesting provider for inclusion in the patient record.

Another core component of the interprofessional consultation services is the acquisition of advance patient consent. The treating/requesting provider must obtain advanced consent from the patient prior to a psychologist providing consultative services, as it will require a separate copay. APA strongly recommends that psychologists always check the patient’s record to confirm consent has been obtained and documented prior to providing your expert advice.

How do interprofessional consultation services connect to APA initiatives?

APA is dedicated to improving population health, along with advocating for financial incentives that support psychologists’ involvement in these efforts. A population health approach, or preventive health approach, focuses on improving the health, health equity, safety, and well-being of entire populations, including individuals within those populations. Providing interprofessional consultation services is an important part of addressing population health as well as increased integration of mental and behavioral health services in interdisciplinary settings. Further, interprofessional consultation services have the potential to enhance quality and coordination of care and address persistent workforce shortages that are impacting patient access to medically necessary mental health treatment.

Clinical examples

Case 1

A primary care physician (PCP) consults a psychologist by telephone conversation. The PCP states that consultative services are needed for a 20-year-old Latinx female patient who presents with flat affect, weight gain, and significant fatigue. The patient reports that she has been staying up until 3 or 4 a.m. and sleeping all day. She failed two of her classes and will have to attend summer school to make up the credits. Her PHQ-9A is elevated (14) and she reports having thoughts of harming herself on item 9.

The psychologist consultant reviews the case and verbally provides the PCP with assessment and management recommendations which include the need to complete a risk assessment and safety plan prior to leaving the clinic, a plan to conduct ongoing safety checks, and referral to a community therapist. Also, recommendations on sleep hygiene, behavioral activation, and lifestyle issues related to weight management. The psychologist then writes up the assessment and management recommendations and transmits the report to the treating/requesting provider for inclusion in the patient medical record.

Billing: Report one unit of CPT code 99449, indicating the psychologist spent a total of 35 minutes of consultative services, including 20 minutes of verbal discussion with the patient’s treating provider, and 15 additional minutes reviewing the patient’s medical record, doing research review, creating and sending the written report of findings, and expert advice.

Case 2

A pediatrician consults a psychologist electronically through the EHR. The pediatrician states reason for consult: “Patient is 4-year-old child with speech delay that is exhibiting impulsive behaviors that include tantrums and aggression towards siblings. Pediatrician indicates they are looking for guidance on typical development, differentiating ADHD from other disruptive behavior problems, and possible non-medication treatment options.”

The psychologist consultant reviews the case and provides assessment and management recommendations which includes information regarding differential diagnosis of ADHD or disruptive behavior disorders, including discussion of diagnostic criteria and patient’s symptom presentation. Psychologist consultant recommends evidence-based behavioral therapy interventions for disruptive behavior particularly those emphasizing the increase in positive attachment/warmth and decreasing harsh/coercive parenting.

Time: 16 minutes total time. (10 minutes of responding to the patient’s treating provider via EHR about the case and giving recommendations and six additional minutes of chart review and documentation).

Billing: Report one unit of CPT code 99451, indicating the psychologist spent a total of 16 minutes: 5 minutes performing consultative services, and 10 minutes responding to the patient’s treating provider via EHR about the case and creating and sending the written report of recommendations to treating provider (all communication was electronic).

Billing and coding guidance

Interprofessional consultations are time-based services; therefore, psychologists are required to document the start and stop times and/or total time spent providing consultation services. When reporting consultation services that require both a verbal and written report (codes 99446–99449), code selection is based on cumulative, even if that time occurs on multiple days.

CPT Code

Descriptor

2023 wRVU

2023 Medicare Non-Facility Payment Rate

2023 Medicare Facility Payment Rate

Interprofessional Telephone/Internet/Electronic Health Record Consultations

Consultation Services with Discussion, Verbal and Written Report Required

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

$17.96

$17.96

99447

11–20 minutes of medical consultative discussion and review

0.70

$35.58

$35.58

99448

21–30 minutes of medical consultative discussion and review

1.05

$54.22

$54.22

99449

31 minutes or more of medical consultative discussion and review

1.40

$71.84

$71.84

Consultation Services without Discussion, Only a Written Report Required

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

0.70

$35.58

$35.58

  • Do not report codes 99446, 99447, 99448, 99449, or 99451 more than once for the same patient in a 7-day period.
  • When performed on the same date of service as….
  • Do not report 99446, 99447, 99448, or 99449, if greater than 50% of time is spent in data review and/or analysis, do not bill those codes.
  • Do not bill 99451 for services that last less than five minutes of consultative service.

Treating providers can request the opinion and/or treatment advice of a physician or other QHP, such as a psychologist, that has specific specialty expertise, to assist in diagnosis and/or management of the patient’s problem, without the consulting provider ever seeing the patient.

When consultative services are requested, the patient can be a new or an established patient to the consultant, and the condition for which the consultation is being requested can be a new or existing problem.

Proper reporting of interprofessional consultation services can occur as long as:

  • The psychologist consultant has not had a face-to-face visit with the patient within the last 14 days, and/or
  • The consultation services provided by the psychologist does not result in a face-to-face service with the patient within the next 14 days.

The following are examples of situations where it would not be appropriate to report interprofessional consultation services:

  • If an in-person visit with the psychologist consultant has occurred within the previous 14 days or will occur within the next 14 days.
  • If the sole purpose of the communication with a treating provider is to arrange transfer of care or an in-person consultation with the psychologist consultant.

Additionally, interprofessional consultation services cannot be reported more than once, for the same patient, in a 7-day period.

The following are required items to be documented in the patient medical record when these services are provided:

  • Verbal consent was obtained by the treating/requesting provider for the interprofessional consultation from the patient/family.
  • The treating/requesting provider’s written or verbal request, as well as the reason the request was made, for the consult.
  • The amount of time spent providing the interprofessional consultation services, and should be reported based on cumulative time spent, even if that time occurs on subsequent days.

APA recommends that, in order to reduce the risk of your claim(s) being denied for reporting noncovered/noncontracted codes, you should check each payer policy, as well as the list of codes included in your contract with each payer, to determine which codes are covered/reimbursed. Additionally, please refer to APA’s Payers Guide: Utilizing Interprofessional Telephone/Internet/Electronic Health Record Consultations CPT® Codes for Psychologists for further information on advocating for coverage of these services.

National Correct Coding Initiative (NCCI) edits for interprofessional consultations and psychological services

NCCI has specifically indicated that you cannot provide psychotherapy services and interprofessional consultation services, for the same patient, on the same date of service.

It is important to note however, that while specific NCCI edits do not exist for code(s)/service(s) typically provided and reported by psychologists, the psychologist consultant cannot report interprofessional consultation services if:

  • they had a face-to-face visit with the patient within the last 14 days, and/or
  • the consultation services provided by the psychologist results in a face-to-face visit with the patient within the next 14 days.

Column 1

Column 2

Modifier Indicator

Rationale

90791

99446, 99447, 99448, 99449, and 99451

Misuse of column two code with column one code

90832

99446, 99447, 99448, 99449, and 99451

CPT Manual or CMS manual coding instructions

90834

99446, 99447, 99448, 99449, and 99451

CPT Manual or CMS manual coding instructions

90837

99446, 99447, 99448, 99449, and 99451

CPT Manual or CMS manual coding instructions

99446, 99447, 99448, 99449, and 99451

96127

Misuse of column two code with column one code

How to report interprofessional consultation services on your claim form

Psychologists should bill interprofessional consultation services based on whether the consult was with or without discussion and the time spent providing the consultation.

If the consult was with discussion, the psychologist will bill codes 99446–99449, based on the total/cumulative time devoted to performing the service. Code selection is then based on the specified time frames stated in the CPT code descriptors (99446: 5–10 minutes, 99447: 11–20 minutes, 99448: 21–30 minutes, and 99449: 31+ minutes).

If the consult was without discussion and greater than five minutes, 99451 is billed.

The patient for whom the interprofessional telephone/internet/electronic health record consultation is requested may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem. The consulting provider, however, cannot have a face-to-face encounter with the patient 14 days before or after offering treatment recommendations to the attending provider.

Additional resources

Related and recent

American Psychological Association. (2023, February 23). How to report interprofessional telephone/internet/electronic health record consultations. https://www.apaservices.org/practice/reimbursement/health-codes/interprofessional-record-health-consultations

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How to report interprofessional telephone/internet/electronic health record consultations (2024)

FAQs

What is an interprofessional telephone internet electronic health record consultation? ›

An interprofessional telephone/internet consultation is defined as an assessment and management service in which a patient's treating provider (e.g., primary or qualified health professional [QHP]) requests the opinion and/or treatment advice of a consultant with specific specialty expertise to assist the treating ...

How to bill for e-consults? ›

To get specific coverage information, you can ask your insurance provider about coverage for CPT Code 99451, which is the most likely charge code the specialist will utilize, or additional potential codes 99446-99449. If the specialist recommends a referral, there will be no charge for the eConsult.

How to bill 99449? ›

Billing: Report one unit of CPT code 99449, indicating the psychologist spent a total of 35 minutes of consultative services, including 20 minutes of verbal discussion with the patient's treating provider, and 15 additional minutes reviewing the patient's medical record, doing research review, creating and sending the ...

What is the CPT code for interprofessional consultation? ›

Answer: 99446-99449 require verbal and written feedback. Over half of the time must be spent in this verbal/electronic feedback.

What are the disadvantages of telephone consultations? ›

Disadvantages of telephone consultations include: Difficulty building patient-doctor relationship (e.g. more difficult to demonstrate empathy and understanding) Communication may be more challenging (e.g. patients less likely to volunteer hidden agenda; potential to miss cues) Limited examination.

How does a telephone consultation work? ›

There are five key steps in a telephone consultation; patient introduction, information gathering, establishing a working diagnosis and plan for clinical care, planning the next step and closing the consultation.

What are the three R's that are needed to bill a consultation? ›

When physicians code a consultation, they should follow the three Rs:
  • Request. The consulting physician should receive a written request, including the reason for the consultation, from an appropriate source. ...
  • Render an opinion or advice. ...
  • Report information in a shared record.

Does Medicare pay for e-consults? ›

Medi-Cal covers synchronous telehealth (e.g., video synchronous interaction and audio-only synchronous interaction) and asynchronous telehealth (e.g., store and forward and e-consults) across multiple services and delivery systems, including physical health, dental, specialty and non-specialty mental health, and SUD ...

Does Medicare cover interprofessional consults? ›

The Interprofessional Consultant Services

CMS requires that Medicaid plans cover these services, however as of 3/1/2023 they are not in the Ohio Medicaid fee schedule. They are covered by Medicare and many commercial contracts.

What is the difference between 99451 and 99452? ›

CPT codes 99451 and 99452 report the services of providers who work together on behalf of a patient, using any of the three modes of communication. Code 99451 is reported by the consultant, and code 99452 is reported by the treating/requesting provider.

What is CPT code 99452 billing guidelines? ›

Reading AAPC article: https://www.aapc.com/codes/coding-n...icesthat99451and99452represent-159856-article states: "99452 represents when a provider (such as the patient's primary care physician or other qualified health care professional) interacts with a consulting provider via telephone, the internet, or an EHR.

What is the billing code 99447? ›

The Current Procedural Terminology (CPT®) code 99447 as maintained by American Medical Association, is a medical procedural code under the range - Interprofessional Telephone/Internet/Electronic Health Record Consultations.

How to bill for telephone visits? ›

For virtual/telephonic visits that do not meet the requirements above, the billing entity should bill the corresponding virtual/telephonic visit CPT or HCPCS code(s) listed in Section I and will be reimbursed the Medi-Cal FFS rate on file for the applicable procedure code or bill their MCP as appropriate.

What is the CPT code for telephone consultation physician? ›

The following codes may be used by physicians or other qualified health professionals who may report E/M services: 99441: telephone E/M service; 5-10 minutes of medical discussion. 99442: telephone E/M service; 11-20 minutes of medical discussion. 99443: telephone E/M service, 21-30 minutes of medical discussion.

What is the ICD 10 code for professional consultation? ›

ICD-10 Code for Person consulting for explanation of examination or test findings- Z71. 2- Codify by AAPC.

What is a doctor's telephone consultation? ›

The purpose of telephone consultations is to ensure that all patients are dealt with appropriately by a member of the practice team. The receptionists will take your details and confirm the correct telephone number so that the Doctor can ring you back to discuss the nature of your problem.

What is the difference between an electronic health record and an electronic? ›

An EMR (electronic medical record) is a digital version of a chart with patient information stored in a computer and an EHR (electronic health record) is a digital record of health information.

What is interprofessional communication in healthcare? ›

Interprofessional (IP) communication describes the sharing of information (by means of verbal, writing or other medium) among members of different health professionals to influence patient care positively. This includes communication that may either be intentional or unintentional.

What is an electronic health record specialist? ›

Sometimes called a health information technologist or electronic medical records specialist, EHR specialists are the data-oriented members of a patient's care team. Their responsibilities include: Acquiring, analyzing, storing, and protecting patients' digital records.

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