Cardiology Coding Alert

The common usage of the word referral has thrown a cloud of ambivalence around coding for consults. To cut the confusion, the term referring physician should not be used when you really mean the physician who requested the consultation. In strict coding parlance, a referring physician actually turns over care to another doctor, rather than merely asking for advice.

Cardiologists are often called upon to consult with attending physicians; yet, choosing the correct evaluation and management (E/M) code for consults can be confusing. Is your service really a consult? Or a direct transfer of care? Choose the wrong answer and you could be targeted for an audit, warn cardiology coding experts.

Charging for a consult when you shouldnt is the mistake I see most often, says Jeanette Cost-Blubaugh, CPC, business office manager, Mid-Ohio Heart Clinic, Mansfield, OH and consultant for Corporate Medical Consulting.

But in order for your cardiology practice to bill correctly, you need to know these basics behind coding for consults.

1. Learning the basic definitions will help you distinguish between consults and transfers. An attending physician is responsible for providing the patients overall care. If the attending physician needs an opinion or advice regarding the treatment, diagnosis, or management of a specific problem, he or she then requests a consultation from another doctor.

Essentially, the attending physician is saying Take a look and tell me what you think about the problem and give me your opinion, but the overall care of the patient remains with me, says Susan Garrison, MPC, CPC, CPC-H, CPAR, president-elect of the American Academy of Professional Coders and senior manager at Hyatt, Imler, Ott, and Blount, a coding and billing consulting firm in Atlanta.

On the other hand, if the message the attending physician sends is You take over the care, that is a referral, or transfer of care, she points out.

A major difficulty in distinguishing between a consult and a referral occurs because the consultant -- the physician giving the advice or opinion -- can also perform diagnostic or therapeutic services in order to render an opinion, explain Plunket and Cost-Blubaugh.

Some coders feel that once the consulting physician initiates any kind of treatment, he or she is then no longer [merely] consulting [but instead has taken over the patient], but I dont agree with that, Cost-Blubaugh opines.

For example, perhaps the cardiologist needs to do a stress test or a catheterization in order to form his or her opinion, Plunket adds. It is not the presence or absence of these tests or procedures that indicates whether the new physician is taking over the care, Cost-Blubaugh maintains. Even if the consultant initiates care, if he or she reports the findings back to the requesting physician, [...]