Anesthesia Coding Alert

Question: A primary-care physician referred a patient to our pain management practice for a consult. She was an established patient, but we haven't seen her in a year. Our physician says we should bill 99215 because we can't bill consult codes for Medicare patients if we've seen them for the same problem in less than two years. How should we handle this visit?

Answer: The answer depends partly on the consult's purpose: Is the primary-care physician asking for an additional opinion regarding the established condition?

If the primary-care physician asked for more advice regarding the condition of an established patient, you can bill for an additional consult with 99241-99245 (Office consultation for a new or established patient ...).

If not, the patient is still an established patient with an established condition -- but you report the time as an established patient visit (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) instead of a consult.