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Pulmonology Coding Alert

Reader Question:

Follow Criteria to Report Consultation Codes

Published on Sun Oct 12, 2003

Question: A patient's primary-care physician (PCP) exhausted all treatment options for a persistent cough and sent him to our office. Should I report new patient office visit codes?

Maine Subscriber
 
Answer: Report the appropriate new patient code (99201-99205) unless you can satisfy all the CPT requirements for submitting consultation codes (99241-99245). Coding experts recommend that you follow these three steps:
 
1. You've already met the first requirement - that another physician requested your pulmonologist evaluation.   

Your physician should document the request in the patient's medical record. For example, your physician should write in the patient's medical record that he saw the patient at the PCP's request. Or, when your pulmonologist writes a letter back to the requesting physician, he can write, "Thank you for allowing me to see your patient in consultation" or "I had the pleasure of seeing your patient in consultation."
 
2. The second factor depends on the visit's intent. If the PCP feels that only your pulmonologist should provide the patient's care, and has documented a transfer of care to your physician prior to the visit, you should report new patient visit codes (99201-99205). But, if the PCP sent the patient to your physician for an opinion on how best to manage the patient, you can bill for consultation services. Also, to qualify as a consultation, your pulmonologist may initiate treatment for the persistent cough (786.2) and may authorize a follow-up visit (99211-99215) to evaluate the response to treatment.
 
3. In a letter, your pulmonologist must relate his opinion regarding the patient's condition to the PCP. For example, your physician may note that the patient has bronchitis (491.x) and include a suggested treatment plan.

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