Orthopedic Coding Alert

Question: We are a small orthopedic practice and we often refer patients to a local hand surgeon. The hand surgery practice saw your April article -This Tool Can Make Your Consult Documentation Complete,- which recommended that surgeons fax a consult request form to the requesting physician before the surgeon performs a consult. This way, the surgeon ensures that he always has consult requests in writing. But this hand surgeon faxes us the form every time we send any patient to him--even when we are transferring care of the patient to the hand surgeon. Is this necessary?


Rhode Island Subscriber

Answer: No. The only time the hand surgeon will need to send your practice the consult request form is when one of your orthopedists specifically asks the hand surgeon to perform a consultation but fails to put his consult request in writing. In those cases, the hand surgeon can send your practice the form to ensure that you-ve given him clear documentation of the consult request.

If you simply refer a patient to the hand surgeon--meaning that your orthopedic surgeon transfers the patient's care to the hand surgeon--then from a coding standpoint, there is no need for a written request of the referral. In fact, if the hand surgeon asks you to fill out the consult request form every time you refer a patient, there is a chance that he is actually billing the visits as consults (99241-99245) and not as new or established patient office visits (99201-99215).

If that is the case, he may be upcoding the visits, because consults pay more than office visits.

In addition, if you always send your consult requests to the hand surgeon in writing, you shouldn't need to fill out the consult request form, since you-ve already provided a written request for the service.