Urology Coding Alert

 We've examined your queries, now we tackle the solutions If you're still trying to get a handle on the consultation coding guidelines, let us help you get on the right track. We've gathered your top-five consult coding questions and put our experts to the test. Review the following questions and answers to get the lowdown on everything from preoperative clearances to second opinions.
 
1. Don't Stress About Consult Frequency Question: How often can we report consult codes for the same patient? We saw a patient in September for a consult, and then the urologist saw her again for another consultation in March. Can we bill both consults? Answer: The outpatient consultation codes (99241-99245) do not have outlined restrictions on their frequency of use, and it is not necessary for the patient to present with a new problem for an additional consultation code to be appropriate. According to CPT 2006, "If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again."
 
Typically, when a patient returns for an additional consultation, he has a problem unrelated to the original complaint or has a progression of the original problem. If the urologist performs an additional consultation for a given patient, be sure the documentation includes a detailed explanation for the subsequent consultation(s).
 
For example: Suppose a 70-year-old male patient is sent by his primary-care physician (PCP) to a urologist for his opinion and advice concerning a slightly elevated prostate-specific antigen (PSA) level. Following a complete evaluation, no further therapy is recommended and the urologist returns the patient to the PCP for follow-up care.
 
One year later, the PCP performs a repeat PSA that indicates a markedly increased level. The PCP requests another opinion from the same urologist on further management. This second visit to the urologist is considered another consult, and if the service is provided in the office or outpatient facility, choose a code from the range 99241-99245. Meet the Consult Requirements Important: You can collect for a consultation on an established patient if you meet the consult requirements. For example, suppose the urologist sees an established 65-year-old male patient in follow-up for an enlarged prostate gland (600.00) on Monday morning. The urologist examines the patient and renews his medication, warranting office visit code 99213. Later that same week, the patient visits his internist complaining of flank pain. Uncertain of the diagnosis, the internist requests an opinion from the patient's urologist.
 
This second visit to the urologist satisfies the criteria for a consultation and merits a code from range 99241-99245. In this case, the diagnosis is renal colic, 788.0.
 
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