Neurology & Pain Management Coding Alert

Question: A physician in another practice asked our neurologist to perform a patient consult. We saw her four years ago for an unrelated problem. Can we report a new patient consult code for the visit?


Vermont Subscriber

Answer: Because the other physician requests that your neurologist see the patient and offer an opinion, you can bill a consult visit. Choose the appropriate code from 99241-99245 (Office consultation for a new or established patient -), if your physician documents the encounter properly: who requested the consultation, the reason for the consult, a written opinion from your physician regarding his findings, and a written report sent to the requesting physician.
 
The three-year rule explained in CPT's E/M section states that you should consider a patient as -established- if someone in your group sees or treats her within the last three years.
 
Consult codes 99241-99245 apply to both new and established patients, so the three-year rule doesn't apply in this case. If you need to report codes that specify whether the patient is new or established, you could consider this patient as -new- because your group has not seen her in four years.