Hi, let me try to help.
For
KPCcoder - no even if the bone marrow biopsy is on one accession and the peripheral blood smear is on another accession; I would not bill for a clinical consultation charge. Those results are commonly accompanied together for review by a pathologist - also see my explanation on why the bone marrow and peripheral blood smear won't qualify for this. Most pathology reports will state that they referred to accession xxxx for either the bone marrow biopsy or accession AAAA for the peripheral blood smear.
I've reviewed these CPTs not long ago and will provide my opinion okay.
This information is from my notes:
Clinical Consultation 80503-80506 (Both commercial and Medicare payors will pay for these charges).
1) Pathologist first must receive a
"request" from the attending physician - yes it can be phone, in person, on paper, electronic, otherwise in reference to a previously resulted, significantly abnormal test result
2) Consultation must relate to an
abnormal test result that requires medical judgment by a physician (pathologist).
The referenced test must have already been resulted (provided a result, that may possibly be an interpretation from the attending provider already treating the patient)
3) Pathologist must provide a written narrative report in the patient's record
4) The Clinical Consultation must require the exercise of medical judgment by a pathologist, rather that a lab scientist, technologist, or technician. It also must exercise a medical opinion and demonstrate the exercise of medical judgment - (This simply means that the pathologist's can not state "agree with technician", or its an "elevated result"
5) Clinical assessment, evaluation of pathology report and laboratory finding, or other relevant clinical or diagnostic information that requires medical interpretative judgment
6) Calculation of time
(MUST INCLUDE TIME)
Calculation of time includes:
Review patient's medical history
Review patient's test results
Review patient's relevant past and current laboratory, pathology, and clinical information
Arriving at a tentative conclusion/differential diagnosis
Comparing against prior studies/images (radiology) or other testing
Ordering or recommending additional additional follow up testing
Referring and communicating with other health care workers
Counseling and educating the clinician or or other providers
Documenting this all in the patient's medical record; again that must include time.
Okay this isn't crystal clear like I would absolutely prefer, simply (we don't have guidance on this MDM review element.) but from my review on these CPT codes (MY OPINION) this is currently based on total amount of time.
(THAT MUST BE RECORDED IN THE PATIENT'S MEDICAL RECORD). If a pathologist is reviewing those elements for 5-20 minutes or 21-40 minutes or even 41-60 minutes or even additional time, there has to be some reason(s) why something may be not perfect for the patient and the nature of review for your pathologist's interpretation. If your facility is doing these consultations my only advice is make sure it was requested.
The documentation in the patient's medical record should state something like this from my review "A request for consultation was received from Dr. John Wayne on 09/20/2022 via a phone conversation, or personal contact visit, or an order received in the (EHR) Electronic Health Record or simply otherwise (whatever the reason)" to review an abnormal test result along with patient's medical record and other medical history review that
"may" include radiology results, abnormal laboratory tests, other pathology results not performed by them, or other testing.
I apologize in advance if my advice is lengthy, I had a few pages a few pages of hand scribed notes and just gave a brief overview on the stuff I found in my discovery process on these new clinical consultation codes.
Thank you for listening this evening, also if anyone has anything to add to my post please feel free to do so If I erroneously missed something. If someone has documentation or guidelines to state otherwise to my advice, now would be the time to share that alright please. I'd like to believe I am current on coding but sometimes those little things fall through the cracks and I'd love any feedback you may have.
Have a fantastic evening!
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT