Otolaryngology Coding Alert

Treatment delay or change makes 99261-99263 appropriate--at least for now

You won't have to worry about coding follow-up consultations in 2006. But until the new year arrives, here's how to use 99261-99263 correctly.

True follow-up consults rarely occur, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. In fact, you should report a follow-up consult for the same individual (99261-99263, Follow-up inpatient consultation for an established patient ...) only under two circumstances.

1. -If the otolaryngologist can't give a treatment recommendation until he gets test results back, the subsequent encounter could count as a follow-up consultation,- Callaway says. That would mean the physician did not give any statement on the patient during the first visit.

2. After an otolaryngologist completes patient treatment, a subsequent visit may qualify for 99261-99263. The physician may request the otolaryngologist's opinion because the patient's condition has changed and/or the patient requires a different plan of care.
 
Note: To report 99261-99263 for the above encounters, the service would have to meet a consultation's three requirements, including a request for opinion, rendering of services, and a report to the requesting physician. For inpatient consultations, documentation in the patient's shared medical record suffices.