Oncology & Hematology Coding Alert

Question: A patient's primary-care physician (PCP) noticed a suspicious growth on a patient's lung and sent him to our office. Is this a new patient visit or a consultation?

Maine Subscriber
 
Answer: You should report the appropriate new patient code (99201-99205) unless you can satisfy the following requirements for submitting office consultation codes (99241-99245):
 
1. You've already met the first requirement - that another physician requested that your oncologist evaluate the patient. Your physician should document the request in the patient's medical record. For example, your physician should write in the patient's medical record that he or she saw the patient at the PCP's request. Or, when your oncologist writes a letter back to the requesting physician, he or she can write, "Thank you for allowing me to see your patient in consultation" or "I had the pleasure of seeing your patient in consultation."
 
2. The second factor depends on the visit's intent. If the PCP feels that only your oncologist should provide the patient's care, and has documented a transfer of care to your physician prior to the visit, you should report new patient visit codes (99201-99205). On the other hand, if the PCP sent the patient to your physician for patient management advice and the patient will return to the PCP for continued treatment, you can bill for your oncologist's consultation services. Also, to qualify as a consultation, your oncologist may initiate treatment for a diagnosis such as a persistent cough and may authorize a follow-up visit (99211-99215) to evaluate the response to treatment.
 
3. In a letter, your oncologist must relate his or her opinion regarding the patient's condition to the PCP. For example, your physician may note that the patient has lung cancer (162.x) and include a suggested treatment plan.