Radiology Coding Alert

Consults go through a major shake-up in 2006

Put the checking of E/M code changes at the top of your “must-do” list. You’ll find that follow-up and confirmatory consult coding is very different in 2006.

• Delete follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient ...).
 
New method: When a radiologist receives a proper request for a consult in the inpatient setting, you may code for an initial inpatient consult (99251-99255, Initial inpatient consultation for a new or established patient ...). These codes haven’t changed for 2006.
 
If the radiologist continues to see the same patient during the same inpatient stay, you should report subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...), not follow-up inpatient consult codes (99261-99263, which CPT Codes 2006 eliminates).

Physicians often misuse the follow-up consultation codes, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. The coding change should clarify CPT’s intent and decrease accidental miscoding of these services.  • Forget confirmatory consultation codes 99271 -99275 (Confirmatory consultation for a new or established patient ...).

New method: A confirmatory consultation could qualify as an office visit, an outpatient consultation, or an inpatient consult, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.

If the visit meets a consultation’s three requirements--request for opinion, rendering of services, and reporting back to the requester--you should report a consult code. If the patient “self-refers”--presents on her own initiative rather than at the request of a physician--you’ll probably report a standard new patient or established patient E/M code (99201-99215) in 2006.

Watch for: If the patient comes to you because an insurance company requires a second opinion, the payer may require you to append modifier 32 (Mandated services) to the E/M code.

You may not code for these services regularly, says Terrence Leone, CPC, CIC, CMBS, radiology coding specialist with Catamount Associates in New York and member of the AAPC National Advisory Board. But you need to know the rules to avoid mistakes when the occasion arises.