General Surgery Coding Alert

Question: Other physicians often ask surgeons in our practice for a consultation on a case. How should we bill the consultation? Does our surgeon have to take over the care of the patient to be able to bill a consultation?

Iowa Subscriber

Answer: You should report a consultation code such as 99241-99245 (Office consultation for a new or established patient ...) if your surgeon, upon request of another physician, evaluates a patient for a certain condition and either does or does not take over treatment of the condition. The surgeon does not assume a transfer of care for a consultation service.

You can think of the patient as being “borrowed.” The patient however, will need to return to the referring physician during the course of management. After the consultant sees the patient, the patient can go back to the originating provider to discuss the options, see another consultant, or perhaps, decide to have the consultant take care of the issue. The intent of that original visit is still that of a consultation.

Remember: To bill a consultation code, you need to ensure your provider’s documentation meets the following criteria:

• Reason for consult
• Request for your doctor’s opinion
• Rendering the service in order to develop an opinion (the consult visit)
• Write a letter (or auto generate a letter) to the requesting doctor with the opinion
• Return the patient once the course of treatment is complete.

Check with your payer: If you are billing Medicare or another payer that no longer recognizes the consultation codes, then you cannot use these codes for the consultation. The intent of the visit doesn’t change, however, and you should report the service with a new or established office/outpatient visit code.