Cardiology Coding Alert

Question: We are a large cardiology group, and the same question about consults keeps coming up with our physicians. Say Dr. A is following a patient for congestive heart failure. During Dr. As shift as the covering cardiologist at the hospital, this same patient presents to the hospital for a different cardiac condition (i.e., chest pain). The emergency room (ER) or attending physician calls Dr. A in for a consult on this patients condition. Can this be coded as a consult? Also, if another physician from the same group is called in to consult on this patient, is this a billable consult?

Rhode Island Subscriber

Answer: If the ER physician clearly is requesting the cardiologists opinion and not looking for a transfer of care, then the service can be billed as a consult, says Terry Fletcher, BS, CPC, a coding and reimbursement specialist in Laguna Beach, Calif. She notes, however, that ER physicians tend not to hang on to their patients. If the patient has a known problem (e.g., coronary artery disease, malignant hypertension, etc.), common sense dictates that the ER physician is not looking for your opinion. They want you to assume the care and treatment of the patient. She notes that if the patient is showing a sign or symptom or an acute problem for which a cardiologists opinion is warranted to determine treatment, then a consult may be appropriate if no transfer of care occurs.

If the opinion of a second physician in the same practice with the same tax ID number is required, the service cannot be billed as a consult unless it takes place on another day or the second physician is in a separate, recognized specialty. Subspecialties (e.g., electrophysiology) do not count.