Gastroenterology Coding Alert

Question: We-ve heard conflicting information about the requirement for a written request before our gastro-enterologist can bill for a consult. Must the request be in written form from the requesting physician, or can our gastroenterologist (the consulting physician) merely note the request in the patient record?


Florida Subscriber
Answer: Best practice dictates that you receive a written request for the consult from the requesting physician. This verifies, without a doubt, that the requesting physician intended for the gastroenterologist to provide a consult (rather than to assume the patient's care) and provides solid documentation to back up your choice of a consultation code (rather than a standard inpatient or outpatient care code).

But nothing in CPT or CMS guidelines absolutely requires a written request to report a consult.

The Medicare Carriers Manual, for instance, says the patient's record must have a written -notation- of the consult request, but it does not specifically state that the request must be in writing. Often, in fact, one doctor will phone another doctor, or meet him in the hallway, and request a consultation verbally. In such cases, the consulting doctor should simply write in the patient's progress notes that she's evaluating the patient at the request of -Doctor X.-

CMS also released a -Medlearn Matters- article (SE-0515) late last year that stated definitively you don't need a letter from the requesting physician to prove a visit was a consult. Rather, you just need a note in the patient's medical record. To confuse matters somewhat, the agency has since withdrawn the article from its Web site.

Tip: To improve documentation when the requesting physician does not provide a written request, make up your own consultation form. For instance, when you receive the phone call from Dr. X's office, you can fax back a form for Dr. X to sign requesting the consult.

Although not required, this step will give you extra protection in case of an audit.