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Urology Coding Alert

Reader Question:

Vasectomy Referral

Published on Wed Mar 01, 2000

Question: If a patient asks his primary-care doctor about a vasectomy and is referred to a urologist, should this be a consult or a new patient visit?

Anonymous Oklahoma Subscriber

Answer: This would not be a consultation. If the primary-care doctor is simply sending the patient to you to have the vasectomy done, you should code this as a new patient visit (99201-99205). Coders should change the claim from a consultation to a new patient before filing it. Many doctors respond to this piece of bad news by telling their coders, But I wrote a report! The answer to that is: Just writing a report does not qualify as a visit for a consultation. Yes, every consultation requires a report, but not everything that gets a report is a consultation. This is a clear case of transfer of care, not a consultation. The key concept to remember here is intent. While the physician may fulfill the three components of a consult, this is still a new patient because it was the primary-care physicians intent to transfer care.
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