Cardiology Coding Alert

Question: Our cardiologist was recently on-call for the emergency department (ED). The ED physician asked for the cardiologist's opinion regarding a patient's condition and asked the cardiologist to recommend treatment options. How should we report this consult service in the ED?


Nevada Subscriber

Answer: You should report office or other outpatient consult codes (99241-99245) for true consultations that your cardiologist provides in the ED. Many physicians and coders mistakenly believe that they should use outpatient consult codes for office visits only. In fact, such consultations may occur in any outpatient environment, including the ED.

The CPT introduction to "Office or Other Outpatient Consultations" states that you should use 99241-99245 "to report consultations provided in the physician's office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, custodial care, or emergency department." You should report a consultation code only if the cardiologist meets certain criteria.
 
The real question is, did the ED physician request your cardiologist's opinion, or did the ED physician hand the patient over to the cardiologist?

For the visit to qualify as a consultation, the treating physician must specifically request the cardiologist's opinion, and the cardiologist must send a report back to the ED physician.

If your cardiologist simply took over the patient's care, you should report the appropriate outpatient E/M code (99201-99215, Office or other outpatient visit for the E/M of a patient ...) or admission code (99221-99223, Initial hospital care, per day, for the E/M of a patient ...) instead of a consult code.