Transfer of Care

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York, PA
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My doctor is having me brief him on coding quidelines for transfer of care and I need a little help. I'm looking for more information on how to code instances when our doctor is requested by another to consult with a patient, and then decides to take over patient care. I'm looking at the code set and guidelines for Consultations in the E/M section of CPT, and I'm a little confused.

Our doctor's initial consult with the patient would be coded with set 99241-99245. At that point he takes over care and has the patient admitted from ER to his care. According to guidelines "if subsequent to the completion of a consultation the consultant assumes responsibility for management of a portion or all of the patient's condition, the appropriate E/M services code for the site of service should be reported."

Does this mean that our doctor has to do another, different consultation with the patient and use correct code for that, or after assigning code from 99241-99245, we can just add on the appropriate inpatient consult code, without having to do another consultation.

I'm a little confused. Please help me out. Thanks.
 

btadlock1

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Lubbock, TX
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My doctor is having me brief him on coding quidelines for transfer of care and I need a little help. I'm looking for more information on how to code instances when our doctor is requested by another to consult with a patient, and then decides to take over patient care. I'm looking at the code set and guidelines for Consultations in the E/M section of CPT, and I'm a little confused.

Our doctor's initial consult with the patient would be coded with set 99241-99245. At that point he takes over care and has the patient admitted from ER to his care. According to guidelines "if subsequent to the completion of a consultation the consultant assumes responsibility for management of a portion or all of the patient's condition, the appropriate E/M services code for the site of service should be reported."

Does this mean that our doctor has to do another, different consultation with the patient and use correct code for that, or after assigning code from 99241-99245, we can just add on the appropriate inpatient consult code, without having to do another consultation.

I'm a little confused. Please help me out. Thanks.
You may find this helpful: http://www.ama-assn.org/ama1/pub/upload/mm/362/cpt-consultation-services.pdf

Keep in mind, you don't use consultation codes at all with Medicare (bill an initial inpatient visit for inpatient consults, and bill any follow up visits as subsequent inpatient codes); also, many non-Medicare payers have stopped accepting consultation codes, since Medicare has, so it would be worth it to check with your payers to find out who allows it, and who doesn't. (For those that do allow consult codes, they likely have medical policies pertaining to their requirements for billing consult codes, somewhere on their website.)

Hope that helps! ;)
 
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