Otolaryngology Coding Alert

Question: What type of report meets a consultation's report requirement? Will carbon copying the consultation and sending it to the physician who requested the consult suffice as the "report"? Or must the otolaryngologist issue a separate report from the consult note?

North Dakota Subscriber Answer: Some consultants state that a copy of the chart note fulfills a consultation's (99241-99245, Office consultation for a new or established patient ...) third requirement of a written report. Other experts contend that payers, specifically Medicare, require additional evidence of the consultant's findings.

The latter view may hold weight considering Medicare's report statement. Medicare will pay for a consultation when, "After the consultation is provided, the consultant prepares a written report of his/her findings which is provided to the referring physician," according to the Medicare Carriers Manual.

Of course, the first requirement is that a proper source, such as another doctor, request your otolaryngologist's opinion. Physicians, however, may not make their requests for a consultation clear. For instance, the requesting physician may fax you a letter stating, "I'm referring Patient A to you for your opinion." Even though the note addresses an "opinion," the "referring" implies a referral, rather than a consultation.

With the Office of the Inspector General targeting consultations, you'll want to protect your consultation pay with a more definite request for opinion.

You can easily clarify that another physician requested your otolaryngologist's opinion and that the chart note contains his findings. Here's how: Develop a form letter to put on top of the consultation note. Attach the letter to the chart note's copy and send both sheets to the referring physician as the consultation's "report." The form should state: "Dear Dr. _________, Attached is my consultation report and plan of care for the patient you referred to me for my opinion. Please do not hesitate to call me if you have any questions. Thank you for requesting my opinion."