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Otolaryngology Coding Alert

Are You Using 99241-99245 for ED Visits?:

Heres When Its OK to Do So

Published on Tue Jul 01, 2003

If you routinely bill visits to the ED as consultations, think again unless the visit qualifies as a consultation, reporting 99241-99245 is fraudulent coding.

Three R's Spell Consultation

To report a consultation, you must make sure the otolaryngologist's visit to the ED meets certain criteria, which are often called the three R's. The ED physician must:

  request the ENT's opinion
  state the reason for the consultation
  receive a written report of the ENT's findings.

In addition, all three R's should be documented in the patient's medical chart. "For a consultation in the ED, the request may be documented as part of a plan written in the requesting physician's progress note, an order in the medical record, or a specific written request for the consultation," according to the Medicare Carriers Manual section 15506 D. The report may consist of an appropriate entry in the common medical record.

An otolaryngologist may initiate diagnostic and/or therapeutic services at the visit and still qualify as a consultation if the encounter meets the above criteria.
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