Get Compensated for Consultations:
Document and Code Appropriately
Published on Mon Mar 01, 1999
The office and other outpatient consultation codes (99241-99245) are to be used when a physician or other appropriate source sends a patient to your ophthalmology practice for evaluation, opinion and advice, which may include your initiation of treatment prior to returning the patient to the original physician or other appropriate source. Does this mean that the first time you see a patient at the request of another physician that you can always charge a consultation code? No, says Ellen Kaiden, administrator of Westwood Ophthalmology Associates, a two-provider practice in Westwood, NJ. A consult code is appropriate, she explains, if you are asked by another doctor to examine his patient and report on your opinion and advice only, and there is no intent of the requesting physician to transfer to you the specific care of the patient.
Consultation codes pay better than office visit or eye codes, which is why it is important that ophthalmology practices understand when they are appropriate to use. But it can be confusing, because some ophthalmologists use the term consult interchangeably with referral. However, HCFAs Medicare views consult as having a distinct meaning.
Transfer of Care vs. Consult
If your ophthalmologist has been asked to see a patient, and initiates treatment and then continues to see that patient for follow-up for the specific conditionwithout a documented intervening discussion in which the requesting physician asks your ophthalmologist to take over the managementthe likelihood is that the initial service will be viewed by an auditor as a transfer of care, not as a request for a consultation, says Lise Roberts, vice president of Health Care Compliance Strategies, based in Syosset, NY. HCFA understands that the receiving ophthalmologist may still write letters to the requesting physician to update him or her on the care of the patient, but this is viewed by HCFA as appropriate coordination of care with another provider and not a fulfillment of a request for a consultation by itself, Roberts explains. It is the intent of the physician requesting the service [i.e., the sending physician] which must be divined from the available documentation by the auditor. For this reason, many ophthalmologists have adopted a policy of requiring a written consult request from originating physicians. This makes the intent of the requesting physician explicit. If the request is to see and treat, you should not use the consult codes, she says. If the request is to see and render an opinion and advice prior to treatment, the consult codes are appropriate. Keep in mind that it is the requesting physician who will determine the ophthalmologists course of action in this situation.
When we do a consultation, the doctor spends more time, has to write everything down, and has to report [...]
