Cardiology Coding Alert

Question: An ED physician asked for a cardiology consult regarding a patient’s condition and asked the cardiologist to recommend treatment options. There was no transfer of care. How should we report this consult service in the ED? I checked, and the payer does accept consult codes.

Texas Subscriber

Answer: For payers that accept consult codes, you should report office or other outpatient consult codes (99241-99245) for true consultations that your cardiologist provides in the ED. The ED counts as an outpatient environment.

Checking, as you did, that the payer accepts consult codes is important because Medicare and many other payers stopped accepting consult codes several years ago, requiring you to report the most appropriate nonconsult E/M code instead.

Because of the reduced use of consult codes, reviewing the CPT^® rules for reporting consults is a good idea, including confirming that you have a documented request from another physician or appropriate source (among the many possibilities are physical therapists and social workers). The request should relate to care recommendations for a specific issue or the determination of whether the consultant should accept responsibility for patient care, either total or for the specific issue. If transfer of care is the intent all along, then the visit doesn’t count as a consult.

The consultant also should document her opinion and any services ordered or performed. The consultant must share the written report with the requestor (such as the ED physician in this case). Typically, in a hospital environment, a shared medical record is sufficient.