Oncology & Hematology Coding Alert

Plus:  Follow-up consults go through a major shake-up

Make a beeline for the E/M section the minute you get your 2006 manual--you-ll find lots of changes in the  confirmatory and follow-up consult options.

-  Delete follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient -). New method: When an oncologist receives a proper request for a consult in the inpatient setting, you may claim one initial inpatient consult (99251-99255, Initial inpatient consultation for a new or established patient -) per visit. These codes won't change for 2006.

If the oncologist continues to see the same patient during the same inpatient stay, you should report subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient -), not follow-up inpatient consult codes (99261-99263, which CPT 2006 will eliminate).
 
-Physicians never used the follow-up consultation codes correctly,- says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

-  Forget confirmatory consultation codes 99271-99275 (Confirmatory consultation for a new or established patient -). New method: A confirmatory consultation could qualify as an office visit, an outpatient consultation, or an inpatient consult, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.

If the visit meets a consultation's three requirements--request for opinion, rendering of services, and reporting back to the requester--you should report a consult code. If the patient presents to you for a second opinion, generated by herself or her family, you-ll probably report a standard new patient or established patient E/M code (99201-99215) in 2006.

Remember: Your oncology practice may not perform follow-up or inpatient consults often, says Linda Gregory, business office manager for Oregon Hematology Oncology Associates PC in Portland. But being unfamiliar with a service can increase your chances of miscoding, so keep track of how to report these E/M services appropriately.