Otolaryngology Coding Alert

 Heads-up: You should be able to code 4 types of consults Knowing how to report a consultation's correct service level and understanding Medicare's documentation requirements can get your physician's consults paid and keep you compliant with the feds, coding experts say. Spot Consultation Documentation Before you can use consultation codes (99241-99275) with confidence, you should understand how a consult differs from a regular office visit, coding experts say.

Generally, a consultation means a physician, other healthcare practitioner, patient or other third-party has requested that your allergist render advice on a specific problem (such as diagnosing a condition), says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

On the other hand, an office or inpatient visit involves ongoing care of the patient, according to CMS guidelines.

Consultation example: A surgeon requests your allergist's opinion on whether a patient with asthma (493.xx) is fit for surgery. Depending on location and documentation, you could report the appropriate consult code (99241-99275).

If, however, a physician transfers a patient's complete care to your allergist, you would have to choose the appropriate new patient E/M code (99201-99205), Pohlig says. 3 Easy Ways to Support Consultations Because Medicare has received so many incorrectly coded consultations, you may think reporting these visits with accuracy is a daunting task. But you can code consults with ease if you remember the three R's:

Request: Another physician, provider, patient or private insurer has to request your allergist's advice or opinion. Your physician can document this request in his report back to the referring physician, Pohlig says.

Review: This means the allergist has actually evaluated the patient and formulated a plan of care, Pohlig says. For instance, if during a consult your allergist determines that a patient has unspecified allergic alveolitis and pneumonitis (495.9), he should document this diagnosis.

Report: Your allergist has to give the requesting physician a report of his opinion or advice, Pohlig says. In the report, your physician should mention the request, provide his opinion on the patient's condition, and possibly include a treatment plan. How to Code 4 Different Consultations CPT didn't create all consultation codes equally - so you shouldn't code your physician's consults the same way. You'll need to know how to code four different kinds of consultations: 1. Office or other outpatient consultations (99241-99245) You should report 99241-99245 when the allergist provides a consultation in the office or other ambulatory facility, such as the patient's residence, a hospital observation unit or an emergency department.
 
Example: A pediatrician sees a child for the first time and suspects her of having both allergic rhinitis (477.x) and asthma. To confirm the diagnoses, and to receive advice on how to manage [...]