Dermatology Coding Alert

Question: We've heard conflicting information about the requirement for a written request before our dermatologist can bill for a consult. Must the request be in written form from the requesting physician, or can our dermatologist (the consulting physician) merely note the request in the patient record?


California Subscriber

Answer: Best practice dictates that you receive a written request for the consult from the requesting physician. This verifies, without a doubt, that the requesting physician intended for your dermatologist to provide a consult (rather than to assume the patient's care) and provides solid documentation to back up your choice of a consultation code (rather than a standard inpatient or outpatient care code).

But nothing in CPT or CMS guidelines absolutely requires a written request to report a consult.The Medicare Carriers Manual, for instance, says the patient's record must have a written "notation" of the consult request, but it does not specifically state that the request must be in writing.

Often, in fact, one physician will phone another physician, or meet him in the hallway, and request a consultation verbally. In such cases, the consulting physician should simply write in the patient's progress notes that she's evaluating the patient at the request of Doctor X.

CMS also released a "Medlearn Matters" article (SE-0515) late last year that stated definitively you don't need a letter from the requesting physician to prove a visit was a consult. Rather, you just needed a note in the patient's medical record.
 
To confuse matters somewhat, however, the agency has since withdrawn the article from its Web site.

Tip: To improve documentation when the requesting physician does not provide a written request, create your own consultation form.

Example: A primary-care physician calls your office to ask you to evaluate a suspicious-looking mole on his patient's arm.
 
You fax a form to the requesting physician to sign requesting the consult. Although not required, this step will give you extra protection.