Gastroenterology Coding Alert
Pause Briefly Before Coding Repeat Consults
Question: How often can we report consult codes for the same patient? Our gastroenterologist saw a patient in November 2014 for a consult, and then the gastroenterologist saw her again for another consultation in February 2015. Can we bill both consults?
Minnesota Subscriber
Answer: The outpatient consultation codes (99241-99245, Consultation Services) 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 your gastroenterologist performed an additional consultation for a given patient, be sure the documentation includes a detailed explanation for the subsequent consultation(s).
Watch out: 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 GI documented it.
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Pause Briefly Before Coding Repeat Consults
Question: How often can we report consult codes for the same patient? Our gastroenterologist saw a [...]
