Gastroenterology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: A new gastroenterologist recently joined our multispecialty practice. He is seeing a patient whom he has never seen but has been seen by another physician in the practice. Should the gastroenterologist bill a new or established patient evaluation and management (E/M) code?

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Answer: Whether a new or established patient E/M code is billed depends on how recently the patient saw the other physician in your practice, says Cindy McMahan, CPC, an independent coding consultant in Albany, Wisc. If the patient has not been seen by any physician in the practice within the past three years, the gastroenterologist may bill a new patient office visit code (99201-99205). If the patient has been seen by another physician in the practice within the past three years, then the gastroenterologist should bill an established patient office visit code (99211-99215).

If the gastroenterologist is performing a consultation at the request of another physician in the practice, which means he or she offers a medical opinion back to the requesting physician, the gastroenterologist can bill one of the consultation codes (99241-99245 office or outpatient; 99251-99255, initial inpatient; 99261-99263, follow-up inpatient; or 99271-99275, confirmatory consultation), adds McMahan.