EM Coding Alert

Question: Is it true that I cannot bill a consultation if the consulting physician takes over care of the condition the patient is referred for?

Iowa Subscriber

Answer: No, that is not correct. You can report a consultation code (Office consultation for a new or established patient ...) if your physician takes over treatment of the condition but doesn’t not assume a transfer of care.

“A consultant may treat a patient and ultimately take over care for the condition that they have been asked to evaluate,” says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

Analogy: Think of the patient as being “borrowed,” Cobuzzi says. Use the example of a library book versus a book you purchase from the book store and now own. You borrow an item from the library for as long as you need it, but eventually return it to the source (the library). “They don’t say it has to be back in a day, but you need to eventually return it. The same goes for a patient on which your doctors do a consult,” Cobuzzi explains.

After the consultant sees the patient, the patient can go back to the originating provider to discuss the options, see another consultant, or perhaps, decide to have the consultant take care of the issue. The intent of that original visit is still that of a consultation.

Remember: To bill a consultation code, you need to ensure your provider’s documentation meets the following criteria, Cobuzzi warns:

• Reason for consult
  
• Request for your doctor’s opinion
  
• Rendering the service in order to develop an opinion (the consult visit)
  
• Write a letter (or auto generate a letter) to the requesting doctor with the opinion
  
• Return the patient once the course of treatment is complete.
  

Check with your payer: If you are billing Medicare or another payer that no longer recognizes the consultation codes, then you cannot use these codes for the consultation. The intent of the visit doesn’t change, however.