Oncology & Hematology Coding Alert

Question: Patients are visiting our oncology center specifically for consultations, not for a transfer of care. In order for us to charge for the consultation, does the request need to be in writing from the referring provider? Or may we simply document the telephone call requesting the consult?

Pennsylvania Subscriber

Answer: A phone call may not be sufficient unless both your practice and the referring provider document the consult request.

Medicare notes: MLN Matters article 4215 states, "A consultation request may be verbal; however, the verbal interaction identifying the request and reason for a consult must be documented in the patient's medical record by the requesting physician or qualified NPP and also by the consultant physician or qualified NPP in the patient's medical record."

When you-re coding for consultation services (99241-99255), you should check with your individual carriers to be sure you-re following their specific guidelines.

Based on the Medicare regulations, experts note that carriers will pay for a consultation when the physician documents the following five items:

- a request from a referring physician

- the reason for the request

- a patient evaluation

- a written report to the requesting physician

- the patient's return to the requesting physician.

Don't forget: Your request needs to be signed by the requesting provider.

The facts on the ground: Some offices have adopted a fax form for use with consultation requests outside of the office system. When this form is completed, fax it to the requesting provider for signature, and scan it into the office's electronic medical record.

For more information: You can download the complete text of MM-4215 from the CMS Web site at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4215.pdf.