Gastroenterology Coding Alert

Question: Our gastroenterologist handled the preoperative consultation for a surgical case and was asked to see the patient again after surgery. Can we bill an E/M service for this?

Washington Subscriber

Answer: If the surgeon asks the gastroenterologist back after surgery, you can bill an E/M service for this. Whether you can report a consult depends on the payer. CPT has no limitation on the use of consultation codes before and after surgery. On the other hand, Medicare would not consider the post-op visit a consult. Medicare does not allow an outpatient preoperative consult followed by a postoperative consult for the same diagnosis(es) on the same patient. According to Chapter 12, Section 30.6.10(H) of the Medicare Claims Processing Manual (MCPM):

"A physician (primary care or specialist) or qualified NPP [non-physician provider] who performs a postoperative evaluation of a new or established patient at the request of the surgeon may bill the appropriate consultation code for evaluation and management services furnished during the postoperative period following surgery when all of the criteria for the use of the consultation codes are met and that same physician has not already performed a preoperative consultation."

In your scenario, you should report the follow-up "consultation" with an established patient office visit code (99211-99215) or subsequent hospital care code (99241-99245), depending on the site of service.

In the absence of an intervening surgery, if a family physician is asked to re-consult on a patient, it is possible to report a consultation code for both the initial and subsequent consultation services. Section 30.6.10(C) of Chapter 12 of the MCPM states: "In the office or other outpatient setting, the consulting physician or qualified NPP shall use the appropriate Office or Other Outpatient Consultation (new or established patient) codes (99241-99245) for the initial consultation service.

"If an additional request for an opinion or advice, regarding the same or a new problem with the same patient, is received from the same or another physician or qualified NPP and documented in the medical record, the Office or Other Outpatient Consultation (new or established patient) codes (99241-99245) may be used again," the manual says.