Oncology & Hematology Coding Alert

Question: If our physician only reviews patient records, but doesn't actually examine the patient, may we bill a consult (assuming the payer accepts consult codes)?Oregon SubscriberAnswer: Before you report a consult code, you need to be sure the service meets the requirements, including:Written request from a physician or other appropriate sourceMedically necessary reason for the consultationFace-to-face history, exam, and medical decision-making (MDM) rendered by the physician for the patient's problemWritten report sent to the requesting physician with recommendations regarding the patient's care.If your physician does not see the patient, you have no face-to-face encounter to bill and therefore cannot report a consultation (such as 99241-99245, Office consultation ...).Time exception: If the physician sees the patient and does not perform an examination, but the visit qualifies otherwise as a consultation, you may be able to code based on time. The physician would have to document face-to-face counseling and/or coordination-of-care activities dominated [...]