Otolaryngology Coding Alert

Question: One of our otolaryngologists saw a Medicare patient for a consultation. Three weeks later, the patient was seen by the original physicians partner, who shares the same tax identification number. Can the second otolaryngologist bill a new consult, or is a different diagnosis required?

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Answer: After a physician sees a patient, that patient is established at that physicians practice, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J.

There are, however, situations in which a second consult with the same individual may still be claimed, Cobuzzi says, noting that consultations do not distinguish between new and established patients. Therefore, if the patient sees the otolaryngologist for a different complaint (i.e., a different diagnosis), a consult can be billed as long as there was a written request by the patients primary care physician (PCP) and the other criteria for billing a consult have been met.

Even if the patient is sent back to the otolaryngologist for the same problem, you may bill a second consult if the PCP requests another opinion in writing (e.g., the patient is discharged by the PCP and the original treatment has been unsuccessful).

If the second visit is a followup from the initial consultation only (which may be the case here because the patient seems to have returned for the same problem, and there is no mention of a second request for an opinion by the PCP), the second otolaryngologist should bill an established patient visit (9921x).