Gastroenterology Coding Alert

Question: My gastroenterologist wants to bill for the time he spends reviewing medical records when performing a consult. Is 99080 appropriate, or is there another code that would be better?

Ohio Subscriber

Answer: No, 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) would not be correct. Reviewing records is part of the E/M service, according to

CPT guidelines.

Higher level: The record review may still be worth money. If your gastroenterologist documents his review of the record and summarizes it, it increases the data component of medical decision making, which allow for a higher level of service if the

exam and history support that higher level.

Three keys: If your gastroenterologist has taken a detailed history and made a detailed examination, he still needs to show more than low-complexity decision making to qualify for 99244 (Office consultation for a new or established patient,

which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity...), for instance.

Two out of three: To establish a moderate level of medical decision making, you must show that two out of three factors -- number of diagnoses, amount and complexity of data, and level of risk to the patient -- are moderate. If the number of

diagnoses is low, but the amount and complexity of data and the level of risk are moderate, your gastro's MDM score is moderate. Without substantive documentation of the record review, you may have to report 99243 (... of low complexity).