Gastroenterology Coding Alert

Question: For a patient interested in taking the M2A capsule to diagnose her small-bowel pain, one of our physicians requested a consultation from his partner with expertise in the M2A procedure. What chart documentation needs to be present to report a consultation code considering the doctors are partners and they are sharing the chart? Is a letter from the referring physician still required?

Indiana Subscriber

Answer: Before you decide how to report this service, you must decide whether the first gastroenterologist has truly requested a consultation and opinion from his partner. If so, and the doctor specifically asked the M2A specialist for his opinion, this fact must be in the patient's chart to satisfy the "request for consultation" requirement. Separate letters from the requesting and consulting physicians are not needed because both are using a common chart.

In this case, however, you have a request for a specific procedure, not a true consultation. No opinion is really needed. The same is often true when a patient needs an ERCP. Not all physicians in a large GI group necessarily perform every complicated procedure (ERCP, EUS, mucosal resection, variceal ligation, etc.). When a GI advises a patient to have one of these complicated procedures, another member of the group may perform the procedure. The gastroenterologist performing the procedure should not bill a consultation code, but he may bill an E/M office visit service if the patient is seen prior to the procedure for the purpose of discussing the risks, alternatives, etc.

If one of your doctors is referring the patient to his partner because he is the only one who performs M2A procedures, you should not report a consultation code.