Successfully Bill Consultations In and Out of the Office

Although allergists frequently provide consultations, properly reporting these E/M services remains a persistent coding challenge. Documentation is key.
Like other E/M services, allergy coders should choose consult codes according to the three elements of history, examination and medical decision-making. But to bill consults, physicians must also meet other important criteria. And if consultations are not properly documented, payers may confuse consultations with referrals or transfers of care, a road that leads straight to denials.
Code Rhinitis Outpatient Consultations per Consult
Office or other outpatient consultation codes are assigned "to report consultations provided in the physician's office or in an outpatient or other ambulatory facility," according to CPT. A non-hospital-based physician may report a consultation given in the emergency department (ED) if the ED physician or other physician attending the patient requests it.

A physician may report more than one consult for the same patient (for the same or a new problem), as long as the three requirements are met on each occasion. (See "Meet Consultation Requirements With the Three R's.") Any subsequent office visits that the consulted physician initiates, however, must be reported as office visits (99211-99215), says Barbara Johnson, CPC, a coding expert with Loma Linda University Medical Group.
For example, suppose a young male patient with a constant runny nose and other allergic symptoms, which have been worsening with time, sees his primary-care physician (PCP). The PCP documents the patient's symptoms and, due to the condition's severity, requests a consult from the allergist. The allergist examines the patient and determines that a skin test is warranted. Testing confirms a diagnosis of perennial rhinitis (477.9, Allergic rhinitis; cause unspecified). As Medicare's guidelines and most private payers require, the allergist prepares a report for the requesting physician. In addition, he or she discusses treatment options, aggravating factors and preventive measures with the patient.
In this case, the allergist should report the appropriate outpatient consultation code (9924x), along with the code(s) for any skin tests conducted (for example, 95004, Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests]). Any subsequent visits by the same patient for rhinitis treatment would be billed with the appropriate office outpatient codes (9921x), Johnson says.
Code Inpatient Respiratory Consultations Carefully
Initial inpatient consultation codes are used to report consultations provided for hospital inpatients and those in partial hospital settings or nursing facilities. The same physician may report only one inpatient consult per inpatient stay. Additional consults during the same inpatient stay should be billed using the follow-up inpatient codes. If the patient is discharged and readmitted later, however, another initial inpatient consult by the same [...]

- Published on 2002-09-01