Oncology & Hematology Coding Alert

Question: A patient came to the office to see the oncologist, and the patient refused to fill out a history form because he brought his records from another physician. The other physician was another oncologist who requested a second opinion for this patient. Our physician sent a letter to the referring physician and wants to base the coding on time. The patient did not want to be examined, and the physician was unable to obtain a social/family history, review of symptoms, or a history of the present illness. The physician wants to report a consultation code. Is this the correct way to report this service?

Washington Subscriber

Answer: If the other physician sent the patient for a second opinion, with a request for advice and the opinion from your physician -- the consulting oncologist -- you should consider reporting this procedure as a consultation (99241-99245, Office consultation for a new or established patient -).

Important: If this was an insurance-mandated second opinion, you-ll need to append modifier 32 (Mandated services) to your consult code.

The key: To bill a consultation on time alone, however, there must still be a face-to-face encounter between the patient and the consulting physician. If the oncologist reviewed the medical records and evaluated the patient, and then gave the requesting physician his opinion gained from this evaluation and review, you can count the service as a consultation. But without a face-to-face encounter, you shouldn't report a consultation code for a review of the medical records alone.

In addition: Your oncologist will have to send a letter explaining the encounter with the patient and his opinion to the requesting physician to fulfill all the requirements for a consultation.

Tip: To ensure payment for this sort of counseling-dominated visit, your oncologist should note the total time spent and the counseling time. Don't forget to document the following:

- visit total time

- time spent counseling and coordinating care

- a summary of the content of the counseling provided.

Experts note: There is no "easy way" to document time -- in many cases, billing on "time" requires more documentation than coding based on history, examination and medical decision-making.

Check it out: The CPT Assistant, August 2004, provides a good reference for information on time-based coding.

-- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.