Part B Insider (Multispecialty) Coding Alert

Published on Mon Mar 15, 2004 PDF

Consult: A general practitioner sees a patient for an annual preventive exam. During the exam he finds a suspicious-looking mole on the skin of the patient's back. He therefore sends the patient to a dermatologist to have the mole evaluated to see if it poses a skin cancer risk. The physician writes a request for the opinion and his nurse sends this to the dermatologist.

When the patient presents at the dermatologist's office, the dermatologist examines the mole and determines the mole is benign and poses no risk of skin cancer. The dermatologist has thereby rendered the requested opinion. After the exam, the dermatologist sends a written report back to the requesting physician to explain her findings.

You code: As a coder for the dermatologist, you review the medical chart and find a copy of the written request, obvious documentation that the physician rendered the opinion, and a copy of the report of findings. The Three R's are fulfilled and you therefore report 99241 (Office consultation for a new or established patient).

Transfer of Care: A general practitioner diagnoses a patient with adult-onset, Type II diabetes (250.00 -- Diabetes mellitus without mention of complication; type II, not stated as uncontrolled). The physician decides it would be best for the patient to see an endocrinologist to arrange for her diabetes care and maintenance.

When the patient presents at the endocrinologist's office for the first time, the endocrinologist does an extensive exam and history and also spends 30 minutes discussing the patient's concerns, lifestyle changes the patient will need to make and the overall plan of care.

You code: As a coder for the endocrinologist, you report 99204 (Office or other outpatient visit for the evaluation and management of a new patient). You may see in the medical record that the general practitioner and the endocrinologist have been in correspondence over the patient's condition and care. However, this visit is a transfer of care and not a consultation so long as the Three R's are missing. Without a request for opinion from the general practitioner, you can't consider this visit a consult.