Oncology & Hematology Coding Alert

Question: We are a small medical oncology practice and we sometimes refer patients to another practice for surgical procedures. That practice's surgeon faxes us a consult request form every time we send any patient to him, even when we are transferring care of the patient to the surgeon. Is this necessary?

Rhode Island Subscriber

Answer: No. The only time the surgeon needs to send your practice the consult request form is when one of your oncologists specifically asks the surgeon to perform a consultation but fails to put his consult request in writing. In those cases, the surgeon can send your practice the form to ensure that you-ve given him clear documentation of the consult request.

If you simply refer a patient to the surgeon -- meaning that your oncologist transfers the patient's care to the surgeon -- then from a coding standpoint, there is no need for a written request of the referral. In fact, if the surgeon asks you to fill out the consult request form every time you refer a patient, there is a chance that he is actually reporting the visits as consults (99241-99245) and not as new or established patient office visits (99201-99215). If that is the case, he may be upcoding the visits, because consults pay more than office visits.

In addition, if you always send your consult requests to the surgeon in writing, you shouldn't need to fill out the consult request form, since you-ve already provided a written request for the service.