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Gastroenterology Coding Alert

READER QUESTION ~ Stop Counting Gastro's Consults

Published on Mon Nov 27, 2006

Question: How often can we report consult codes for the same patient? We saw a patient in July for a consult, and then the gastroenterologist saw her again for another consultation in October. Can we bill both consults?

Florida Subscriber Answer: The outpatient consultation codes (99241-99245) do not have frequency restrictions, and the patient does not need to present with a new problem for you to use an additional consultation code.

According to CPT, -If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again.-

Typically, when a patient returns for an additional consultation, she has a problem that is unrelated to the original complaint or has a progression of the original problem. If the physician performs an additional consultation for a given patient, be sure the documentation includes a detailed explanation for the subsequent consultation(s).

Watch this rule: Medicare policy (Medicare Claims Processing Manual, Chapter 12) states that -if the consultant continues to care for the patient for the original condition following his/her initial consultation, repeat consultation services shall not be reported.- So be absolutely sure that you can demonstrate the second consultation request and that your physician documented it. Clinical and coding expertise for this issue was provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.
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