Oncology & Hematology Coding Alert

Question: The oncologist submitted a report on a new consult to the requesting physician two weeks after he saw the patient. Has too much time elapsed between the report and consult for us to bill the visit?

Florida Subscriber Answer: Most payers do not have a documented time frame for returning a consultation report. Medicare, however, requires that physicians document a consultation "during, or as soon as practicable after" the service.

To make sure you get paid for consultations, the documentation should include an attending physician's request for an opinion or advice. Also, the oncologist should return the report of his opinion or advice regarding the patient evaluation to the attending physician.

Example: A primary-care physician (PCP) requests your oncologist's opinion and advice concerning a patient with enlarged lymph nodes (289.1, Chronic lymphadenitis). Following the evaluation, the physician should document the official request, the reason for the consultation, and the report on the patient evaluation that the doctor sent to the PCP. To code this, you should select from the consultation code series 99241-99245.