Pediatric Coding Alert

Clip and save your 99241-99245 requirement cheat sheet If you still think of three R's when you hear "consult," your 99241-99245 coding could fall short of the service's current five requirements. In 2006, CMS upped the consultation requirements from three to five based on updated guidelines. Before you garner the extra payment 99241-99245 offer, make sure the encounter satisfies the following criteria: 1. Reason -- The service must be medically necessary. 2. Request -- Another physician or a nonphysician practitioner (NPP) or other appropriate source (CPT only) may generate the request. Don't overlook: The pediatrician must document the request in the chart, says Donelle Holle, RN, past coding and reimbursement director for the department of pediatrics at the University of Michigan Health Systems in Ann Arbor. For instance, "Patient presents today for a consultation from Dr. Smith for recurrent asthma." 3. Render -- The physician can render an opinion, offer advice and order follow-up care. At the time of the consultation, she may initiate diagnostic and/or therapeutic services, says Richard H. Tuck, MD, FAAP, pediatrician with PrimaryCare of Southeastern Ohio in Zanesville. 4. Report -- The consultant must issue a written report back to the requesting source. Hint: Avoid using the term "referral" in your report. Instead, Holle suggests stating, "Thank you for the consultation" or "I saw Johnny in consultation." 5. Return -- The patient returns to the requesting physician or other appropriate source.