Ob-Gyn Coding Alert

Question: If our ob-gyn only reviews patient records but doesn't actually examine the non-Medicare patient, can we bill a consult?

Oregon Subscriber

Answer: A consult is not a consult unless you meet the requirements. These requirements include:

• written request from a physician or other appropriate source
• medically necessary reason for the consultation
• face-to-face history, exam and medical decision-making rendered by the ob-gyn for the patient's problem
• written report sent to the requesting physician with recommendations regarding the patient's care.

If your ob-gyn does not see the patient, you have no face-toface encounter to bill and therefore cannot report a consultation or any E/M service.

If the ob-gyn sees the patient and simply does not perform an examination but the visit qualifies otherwise as a consultation , the physician would have to document face-to-face counseling and/or coordination-of-care activities that dominated the visit to be able to meet the criteria for reporting these codes in the absence of all three key components of history, exam and medical decision-making. Your ob-gyn's documentation would then need to specifically outline the counseling's content. He should also clearly document the total time with the patient and the percent of time he spent counseling (which must be more than 50 percent of the entire visit to report an E/M service based on time).

Pick your level: After that, the ob-gyn should pick the code level based on the typical time included for each E/M code. You may not go to a higher code level until the physician equals or exceeds the total time for that code, according to CPT®.