Gastroenterology Coding Alert

Question: When one of our gastroenterologists refers a patient to another gastroenterologist in the practice for a procedure such as an endoscopic retrograde cholangiopancreatography (ERCP) (43260), can the second gastroenterologist charge for a consultation?

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Answer: Referral does not equal consultation, and the patient should not be billed for a second consultation (99241-99245). A consultation is an E/M service provided by a physician whose opinion or advice is requested by another. Although the first gastroenterologist may be referring the patient to another for a procedure, it is unlikely that he or she is asking the second physician to render an opinion on the patients condition. The referring gastroenterologists evaluation of the patient and the decision to recommend the procedure were performed and documented in the initial consultation.
 
If another visit is necessary to discuss the planned procedure with the performing gastroenterologist, it would be appropriate to charge an established visit code (99212-99215) at a level dependent upon the individual case complexity and visit documentation.
 
You may be confusing the confirmatory consultation codes (99271-99275) with the new or established patient office consultations. The confirmatory consultation codes are used when a second or third opinion on the necessity or appropriateness of a recommended treatment or procedure is requested. However, the physician consultant in a confirmatory consultation is expected to provide only an opinion, which is not your situation.