Healthcare Fraud Shield Latest Article: Are You Seeing an Increase in Digital Medicine Billing?

19 Mar
In 2019, the American Medical Association (AMA) introduced two new codes related to the review and assessment of a patient’s heath record.   The AMA refers to these codes as digital medicine[1].   Several new codes were introduced relating to Remote Patient Monitoring (RPM) and Interprofessional Consultation codes. Today’s article will focus on the new Interprofessional Consultation Current Procedural Terminology (CPT) codes which are as follows:

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
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

What’s the difference?
There were several codes introduced in 2014 that also relate to non-contact services. The table below shows the difference between the old and new codes[2]:
CPT 99451 is written only and reported by the consultant and CPT 99452 is reported by the treating/requesting physician.

What to look for?
  • Both codes are time-based so look for excessive time billed in a day
  • Look for frequency of codes billed per patient, per provider
  • Look for services billed separately that would be considered included. For example, according to Medicare CCI, CPT 99358 and 99359 (prolonged services without face to face contact) would not be allowed with 99451.
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[1]  AMA
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