Gastroenterology Coding Alert

Question: Our practice recently hired another gastroenterologist to help our overworked physician staff. She performed a level-three evaluation and management service for a patient whom she had never seen personally but had been treated by another gastroenterologist in the office. Should we report a new patient E/M code or an established patient E/M code?

South Dakota Subscriber Answer: Which code to use depends on how much time passed between the patient's visits. You can report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity) if the patient has not been treated by any gastroenterologist in the practice for three years or more.

If it has been less than three years since the patient's last office visit, he qualifies for an established patient code and you should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision making of low complexity).

If another physician sends the patient to the gastroenterologist for a consultative opinion, you could use a consultation code (99241-99245, Office consultation for a new or established patient, which requires these three key components ...) even if the patient had been seen within the past three years - as long as the problem is new or if a reasonable amount of time has passed since the last consultative opinion.