EM Coding Alert

Question: Our ophthalmologist performed an office consul­tation on a patient and his insurer does still reimburse for consultations, so we collected for that service. Then another physician sent the same patient to us for a separate consult just a few months later. How much time must elapse before we can bill 99241-99245 again for the same patient?

Illinois Subscriber

Answer: CPT^® and Medicare don’t restrict how often you can report an office consultation for the same patient. You should bill 99241-99245 (Office consultation for a new or established patient, which requires these 3 key components ...) if the visit meets a consultation’s three criteria. An appropriate source, such as another physician, must request your ophthalmologist’s opinion regarding the patient’s situation. Your ophthalmologist must render the examination and then report his findings back to the requester — preferably in writing.

Example: A family practitioner requests your ophthalmologist’s opinion on a 46-year-old female with blurred vision. Your ophthalmologist evaluates the patient and issues a report to the family physician. You code the visit with 99244.

Six months later, another physician requests a consultation for an evaluation of the patient’s eye health following a diagnosis of diabetes. You may report a consultation for this visit as well, even though the consultations occur within the same six months.

Don’t miss: The key to reporting a consultation is the request for an opinion or advice from another appropriate provider. Of course, documentation in the medical record must support all the other requirements in reporting consultation services, but without the request for your physician’s opinion, most payers will not reimburse you for any consultation services.

And as you probably already know, Medicare won’t reimburse for a consult no matter what, so if you are asked for a consult from another physician to evaluate a Medicare patient, you’ll use the office visit codes (99201-99215) instead of the consult codes.