Neurosurgery Coding Alert

One issue not addressed by the AMA in CPT 2008 is a resolution of how to distinguish a consultation from a transfer of care. The CPT Editorial Panel failed to reach a consensus on how to clarify the consult definition at its February meeting, according to the Physician Regulatory Issues Team (PRIT) at CMS.

CMS was hoping the CPT update would settle some of the confusion that the agency created with Transmittal 788, according to PRIT director William Rogers, MD. "A transfer of care occurs when a physician or qualified NPP [nonphysician practitioner] requests that another physician or qualified NPP take over the responsibility for managing the patient's complete care for the condition and does not expect to continue treating or caring for the patient for that condition," CMS wrote.

That sentence worried many surgeons, who thought CMS was barring them from coding a consult when a physician requests an opinion on a patient for a specific problem and the specialist then treats it.

CMS could still clarify the consult issue with another transmittal, but "things have really slowed to a crawl" with preparation for next year's physician fee schedule and other rules, Rogers says. He and another CMS official spoke to the American Academy of Nurse Practitioners last April and "got beat up about the consult issue." So they-re aware that "people would like to see a clarification sooner rather than later," he says.

You-re not likely to receive a denial based on this issue, but it could present a problem in an audit, Rogers says. So far, he hasn't heard of either the Recovery Audit Contractors (RACs) or the carriers auditing providers- consults.

What to do: If a physician sends a patient to your surgeon for a consult and your surgeon decides to treat the problem, send the requesting physician a letter first. The letter should explain the patient's problem and state that the two physicians have agreed that the specialist will initiate treatment.