Gastroenterology Coding Alert

Reader Questions :

Record Review Isn't a Separate Service

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 SubscriberAnswer: 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).
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Gastroenterology Coding Alert

View All