Cardiology Coding Alert

Learn the '3 R's' concept before you report consults within the same practice If you're writing off intra-office consults because you assume you can't bill the consultation codes for members of the same practice, you should reconsider your coding choices. Although you cannot report consult codes for every patient referral within your practice, you may be able to report intra-office consults if you follow four simple rules. Billing consultations can be tricky, but many cardiology practices are even more confused by intraoffice consults -- when your practice provides a consultation at the request of another physician in your group practice. Four basic factors make choosing the correct codes easy. 1. Does Your Visit Meet the Definition of a Consult? The Medicare Carriers Manual (MCM), Section 15506(A) states, "A consultation ... is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician." But you shouldn't just look at that statement and assume that every request for an opinion warrants the consult codes (99241-99263). The MCM goes on to say, "A request for a consultation from an appropriate source and the need for consultation must be documented in the patient's medical record. After the consultation is provided, the consultant prepares a written report of his/her findings, which is provided to the referring physician."

When you aren't sure whether to report a consultation code, use the "Three R's" concept. For you to report a consultation, another practitioner must request your physician's opinion, your physician must render an exam of the patient, and your physician must issue a report to the requesting practitioner. 2. Should You Classify the Service as a 'Transfer of Care'? The MCM states, "Atransfer of care occurs when the referring physician transfers the responsibility for the patient's complete care to the receiving physician at the time of referral, and the receiving physician documents approval of care in advance."

Very few physicians transfer the "complete care" of patients to specialists. Even fewer specialists document approval of care prior to evaluating a patient's condition themselves (for instance, to confirm that they can manage the patient's condition). Transfer of Care? Don't Report Consult Codes Examples of more realistic transfers of care that do not qualify as consultations and are not officially addressed in the MCM are as follows:

The patient becomes dissatisfied with the wait time at his usual cardiologist's office and self-refers to a competing group that boasts a 10-minute wait time. A patient switches from traditional Medicare to a managed-care Medicare replacement option to take full benefit of the new prescription drug bill (the Medicare Modernization Act). The patient switches to an "in-network" cardiologist. A patient with known hyperlipidemia [...]