Oncology & Hematology Coding Alert

Although oncologists frequently provide consultations, properly reporting these E/M services remains a persistent coding challenge. Documentation is key, especially now that the HHS Office of Inspector General has listed consultations as one of the investigative focus areas of 2003. As with E/M services, oncology coders should choose the level of consult codes according to the three elements of history, examination and medical decision-making. To bill consults, physicians must also meet other less clearly delineated important criteria including the ever-thorny documentation requirements, says Judy Murphy, CPC, NCICS, business office supervisor who specializes in radiation oncology with Northwest Cancer Specialists in Portland, Ore. Locate Correct Consultation Codes First CPT 2003 includes four types of consultations: office or other outpatient (99241-99245), initial inpatient (99251-99255), follow-up inpatient (99261-99263), and confirmatory (99271-99275). The first step to using the correct consultation code is identifying the location of the consult, choosing between an office or other outpatient setting (i.e., ER, ambulatory facility or rest home) and an inpatient setting (i.e., hospital, nursing facility or partial hospital setting), says Jennifer Darling, CORT, PA, billing and collections lead with the Center for Oncology Research and Treatment in Dallas. Darling shares the case of a primary-care physician (PCP) who requests the opinion and advice of an oncologist for a 67-year-old female patient with enlarged lymph nodes (289.1, Chronic lymphadenitis). Following a complete evaluation, the oncologist treats the patient on the same day and does not recommend further therapy. Because there has been an official request for the consultation, a documented reason for the consultation, and a written report sent to the attending physician, Darling notes that all criteria have been met for use of an office consultation code. To code this service as an office consultation, you have to choose from the 99241-99245 series, depending on the level of the consult. "Most of our consults come from pulmonary or surgical doctors ob-gyns in particular," Murphy says. "Simply because of the diagnoses that we deal with, almost all of our consults are high-level." Few Limits on Frequency The outpatient consultation codes do not have outlined restrictions on their frequency of use, and patients don't need to present with a new problem for an additional consultation code in the 99241-99245 range to be appropriate, according to the CPT 2003 guidelines.

"A lot of people don't realize that in a free-standing facility, the medical oncologists and the radiation oncologists consult with each other while doing concurrent care, in which a patient is receiving chemotherapy and radiation treatment at the same time," Murphy says.

There are many appropriate treatment sequences for cancer patients. Therefore, coders should get used to a barrage of inpatient and outpatient consult codes that will reflect several specialties initiating consultations [...]