Pulmonology Coding Alert

Question: Can I perform a consult on my own patient?


Florida Subscriber
Answer: Yes and no.

CPT does not restrict consultations to new patients. In fact, consultation codes include this allowance for new or established patients in the code descriptions for outpatient (99241-99245, Office consultation for a new or established patient ...) and inpatient (99251-99255, Initial inpatient consultation for a new or established patient ...) services. You may report a consultation code if you meet the requirements of a consultation.

A perfect example of when to use office consultation codes on established patients involves preoperative exams.

For instance, a gastroenterologist requests your opinion regarding perioperative risk for a patient with COPD to undergo a colonoscopy using moderate sedation. The pulmonologist offers his opinion and sends a report to the gastroenterologist, reporting the preoperative exam as a consultation (99241-99245). Payers usually prefer that you report the diagnoses in this order:

1. the preoperative exam (V72.83, Other specified pre-operative examination)

2. the chronic condition (496, Chronic airway obstruction, not elsewhere classified)

3. the reason for surgery (792.1, Nonspecific abnormal findings in other body substances; stool contents). Some payers may invert #2 and #3.

Exception: Although not consistent with CPT guidelines, state laws and private-payer policies may disallow reporting consultation codes for established patients. Georgia Medicaid prohibits coding a consultation on your own patient. So make sure you know your contracts before coding 99241-99245.