Consult Clarification
Published on Tue Dec 01, 1998
In the October 1998 edition of Cardiology Coding Alert we examined the issue of whether a cardiologist may initiate treatment during the course of a consult.
CPT manual states that a consulting cardiologist may initiate diagnostic and/or therapeutic services.
Section 15506 of Medicare says that a consultation is advice only.
Because HCFA does not have to go by CPT conventions, cardiology practices would do well to make sure their notes document clear communication to and from the requesting physician. This shows that care is not being transferred to the consulting physician, thus enabling practices to adhere to both definitions of consulting.
Remember, if the notes appear that the consulting cardiologist has taken over the care (i.e. no more communication to and from the requesting physician), then HCFA will expect you to use new patient Evaluation and Management codes. For example, your cardiologist is consulting with a patient in the hospital, then you must use the appropriate inpatient hospital consultation code [99251 - 99255] for the initial encounter and then subsequent hospital care codes [99231-99233] for the follow-up visits. If the consulting cardiologist takes over the patients care in the office or outpatient setting, use the appropriate code for that setting [99211-99215].
