Primary Care Coding Alert

Question: Our family physicians (FP) treat many patients for anxiety or depression. We use 99213 or 99214 for these visits. Should we report consultation codes instead, or are these strictly for specialists?

Texas Subscriber
 
Answer: CPT does not restrict consultation codes to specific physicians. To report an office consultation (99241-99245, Office consultation for a new or established patient ...), you must make sure the visit meets the criteria of a consultation. To qualify for 99241-99245, a third party, such as a psychiatrist, would have to request the FP's opinion. And, the FP would have to state the reason for the request and issue a report of his findings to the mental-health specialist.
 
For instance, a psychiatrist may ask an FP's opinion on a patient's physical status to help him determine if drug treatment is appropriate. If the FP meets and documents the consultation requirements, you should assign 99241-99245 for the visit.
 
Often, however, if a patient is already under a psychiatrist's care, the specialist will transfer the patient's medical care, such as monitoring drugs, to the FP. Because the visit involves a transfer of care rather than a request for an opinion, the visit does not qualify as a consultation. Without the consultation requirements, you should code an established patient evaluation for anxiety (300.00, Neurotic disorders; anxiety state, unspecified) or depression (311, Depressive disorder, not elsewhere classified) as an office visit (such as 99213-99214, Office or other outpatient visit for the E/M of an established patient ...), not a consultation.
 
Regardless of the E/M service, you may have difficulty with insurers covering a visit for anxiety or depression. Some payers do not cover any services with mental-disorders diagnoses (290.0-319), unless a
mental-health specialist provides the service.