Dermatology Coding Alert
Meet the 4 R's Before Billing Consults
Question: My physician is being referred patients for "consults" by hospital physicians. When I bill, I am not sure if I should code for a new patient office visit or office consultation. How can I tell the difference? Last December, CMS added reason to the consultation R's. Transmittal 788 requires that the requesting physician document the request and the reason for a consult in the patient's medical record. The answers to the Reader Questions were provided and/or reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.
Oregon Subscriber
Answer: To be able to report a consultation code (99241-99255), there are a few requirements that your physician's visit with the patient must meet. Traditionally, to code a consultation (99241-99255), the encounter had to meet three requirements:
• Request for opinion
• Rendering of services
• Report to the requesting source.
Important: These are Medicare guidelines only, but private payers generally accept them.
Key point: When the physician visits with a patient and renders an opinion for a requesting physician about a patient's condition and then the patient returns to the requesting physician for treatment, it is usually a consultation.
If your doctor is not asked for his opinion about the patient's problem, and he does not provide his opinion on the patient's status during the encounter, it is not a consult.
Alternative: If you don't meet the consult requirements, and the patient has not seen a physician in your practice within the past three years, you should instead select an appropriate-level new patient E/M visit (99201-99205).
Possible fifth R: Billing and coding experts suggest that you pay attention to a fifth R of consultations: return. Demonstrate that the patient only came to see you about a specific problem and that you're returning the patient to the requesting physician for the treatment of that problem. You need to show that there is no transfer of care.
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Meet the 4 R's Before Billing Consults
Question: My physician is being referred patients for "consults" by hospital physicians. When I bill, [...]
