Gastroenterology Coding Alert

With the number of hepatitis C patients growing at an astounding rate, your practice may have to rely on physician assistants, nurse practitioners and clinical nurse specialists to provide appropriate care. That means you'll have to brush up on some new coding skills. Bill Hepatitis Consultations With Care The diagnosis and individualized treatment plans for patients managed by general practitioners are often confirmed during consultations with a specialist such as a gastroenterologist. You need to know how to get the most out of these consults because they may consume much of your time.

According to CPT guidelines, a consultation is a service provided by a physician whose opinion or advice about a specific problem is requested by another physician or other appropriate source. There are several points to remember in order to get full payment for consultations: The written or verbal request for a consultation must be documented in the patient's records. The consulting physician must document his opinion in the records, along with services ordered or performed. The consulting physician must document his findings to the referring physician in a written report. It is appropriate to report a consultation code (99241-99255) when the consultative service is between the same specialty in the same group practice and the above criteria are met. Do not get consultations confused with referrals. If the consulting physician is not in the same domain as the referring physician AND does not communicate his advice to the primary physician, then it is a not a consultation but a referral. Remember that the consulting physician may initiate diagnostic or therapeutic services at the first or subsequent visits. When the consulting physician assumes responsibility for all of the patient's care, the E/M services provided after the initial consultations should be coded for the appropriate level of subsequent hospital care (99231-99233) or the appropriate level of office or other outpatient services (99211-99215). Any other follow-up consultative care should be coded 99261-99263 for inpatient and 99211-99215 for outpatient. Beef Up on Correct Billing for PA Services When a gastroenterologist is the primary caregiver for a hepatitis C patient, he assumes full responsibility for diagnosis, treatment and counseling. Patients often have to schedule regular office visits. Due to the long-term nature of these services, a variety of tasks are undertaken by PAs and/or NPs. A typical visit consists of "a medical exam, lab reviews, medication adjustments, monitoring of side effects, and an investigation of social issues and depression factors. Also, physician assistants educate and train patients on how to self-administer their own injections at home," says Teresa L. Baker, CPC, physician billing manager for the Gastroenterology Division at the University of Michigan. Her practice even has one full-time PA whose job is [...]