How To Use CPT Code 99451

CPT 99451 refers to interprofessional telephone, internet, or electronic health record assessment and management services provided by a consultative physician or other qualified healthcare professional. This article will cover the code description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99451 procedures.

1. What is CPT 99451?

CPT 99451 is a code used to report interprofessional telephone, internet, or electronic health record assessment and management services provided by a consultative physician or other qualified healthcare professional. This code is used when the consulting professional offers an opinion or treatment advice on a case, without meeting the patient face-to-face, and provides a written report to the requesting physician or other qualified healthcare professional.

2. 99451 CPT code description

The official description of CPT code 99451 is: “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.”

3. Procedure

1. The requesting physician or other qualified healthcare professional sends a request for consultation to the consulting physician or other qualified healthcare professional, including the reason for the request.
2. The consultant reviews the patient’s medical records, laboratory and pathology results, imaging studies, and medications.
3. The consultant provides their opinion or treatment advice through telephone, internet, or electronic health record communication.
4. The consultant prepares a written report detailing their findings and recommendations.
5. The written report is sent to the requesting physician or other qualified healthcare professional.

4. Qualifying circumstances

Eligible professionals for providing CPT 99451 services include consultative physicians and other qualified healthcare professionals, such as nurse practitioners, physician assistants, and clinical nurse specialists. The requesting physician or other qualified healthcare professional must document the reason for the request in the patient’s medical record. The consultant must spend at least 5 minutes on the consultation, including reviewing the patient’s information and providing their opinion or treatment advice.

5. When to use CPT code 99451

It is appropriate to bill CPT code 99451 when the following conditions are met:

• The consultation is requested by a treating physician or other qualified healthcare professional.
• The consultant reviews the patient’s medical records, laboratory and pathology results, imaging studies, and medications.
• The consultation is conducted via telephone, internet, or electronic health record communication, without a face-to-face meeting between the patient and the consultant.
• The consultant provides a written report to the requesting physician or other qualified healthcare professional.
• The total time spent on the consultation, including review and communication, is 5 minutes or more.

6. Documentation requirements

To support a claim for CPT 99451, the following information must be documented:

• The request for consultation from the treating physician or other qualified healthcare professional, including the reason for the request.
• The patient’s medical records, laboratory and pathology results, imaging studies, and medications reviewed by the consultant.
• The method of communication used for the consultation (telephone, internet, or electronic health record).
• The written report provided by the consultant, detailing their findings and recommendations.
• The total time spent on the consultation, including review and communication, which must be 5 minutes or more.

7. Billing guidelines

When billing for CPT code 99451, it is essential to follow the appropriate guidelines and rules. Ensure that the consultation meets the qualifying circumstances and documentation requirements outlined above. Additionally, check coding guidelines for proper reporting when the patient and consultant meet face-to-face near the time of the consult.

8. Historical information

CPT 99451 was added to the Current Procedural Terminology system on January 1, 2019. The code was changed on January 1, 2023, to include “other qualified health care professional” in the descriptor, previously referring only to consultative physicians.

9. Similar codes to CPT 99451

Five similar codes to CPT 99451 and how they differ are:

1. CPT 99452: This code is used for interprofessional consultations of 16-30 minutes, whereas CPT 99451 is for consultations of 5 minutes or more.
2. CPT 99453: This code is for remote monitoring of physiologic parameters, not interprofessional consultations.
3. CPT 99446: This code is for interprofessional consultations of 5-10 minutes, but it requires verbal or internet discussion between the consulting and requesting professionals, unlike CPT 99451.
4. CPT 99447: This code is for interprofessional consultations of 11-20 minutes and also requires verbal or internet discussion between the consulting and requesting professionals.
5. CPT 99448: This code is for interprofessional consultations of 21-30 minutes and requires verbal or internet discussion between the consulting and requesting professionals.

10. Examples

Here are 10 detailed examples of CPT code 99451 procedures:

1. A primary care physician requests a consultation from a cardiologist for a patient with uncontrolled hypertension. The cardiologist reviews the patient’s medical records, laboratory results, and medications, and provides a written report with recommendations for treatment adjustments.
2. An endocrinologist is requested to provide a consultation for a patient with newly diagnosed type 2 diabetes. The endocrinologist reviews the patient’s medical history, laboratory results, and current medications, and provides a written report with recommendations for diabetes management.
3. A neurologist is consulted for a patient with recurrent headaches. The neurologist reviews the patient’s medical records, imaging studies, and medications, and provides a written report with recommendations for further evaluation and treatment.
4. A psychiatrist is requested to provide a consultation for a patient with symptoms of depression. The psychiatrist reviews the patient’s medical history, previous treatments, and medications, and provides a written report with recommendations for pharmacological and non-pharmacological interventions.
5. An oncologist is consulted for a patient with a recent cancer diagnosis. The oncologist reviews the patient’s medical records, pathology results, and imaging studies, and provides a written report with recommendations for treatment options and follow-up care.
6. A gastroenterologist is requested to provide a consultation for a patient with persistent abdominal pain. The gastroenterologist reviews the patient’s medical history, laboratory results, and imaging studies, and provides a written report with recommendations for further evaluation and treatment.
7. A rheumatologist is consulted for a patient with suspected rheumatoid arthritis. The rheumatologist reviews the patient’s medical records, laboratory results, and imaging studies, and provides a written report with recommendations for diagnostic testing and treatment options.
8. A nephrologist is requested to provide a consultation for a patient with chronic kidney disease. The nephrologist reviews the patient’s medical history, laboratory results, and medications, and provides a written report with recommendations for management and follow-up care.
9. An infectious disease specialist is consulted for a patient with a complicated infection. The specialist reviews the patient’s medical records, laboratory results, and imaging studies, and provides a written report with recommendations for antimicrobial therapy and follow-up care.
10. A pulmonologist is requested to provide a consultation for a patient with uncontrolled asthma. The pulmonologist reviews the patient’s medical history, previous treatments, and medications, and provides a written report with recommendations for optimizing asthma management.