Otolaryngology Coding Alert

3 steps support consultation coding

If the government finds that your consultation documentation supports only an office visit, Medicare will demand that your office refund the extra 99241-99255 revenue. But you can assess your otolaryngology practice's risk factor and take corrective action now if you do a self-check.
 
Coding experts recommend that you follow these three steps to verify your 9924x coding:

1. Print a report of the consultation visits that you provided in the 99241-99255 series and randomly pick out five for each of your otolaryngologists, says Betsy Nicoletti, CPC, a consultant with Helms & Company, a physician practice management company in Concord, N.H.

2. Check that documentation shows that a proper source requested the otolaryngologist's opinion and that your office sent a report to the requesting physician. To verify that the primary-care physician documented the request for opinion, ask to see his charts. You don't need to audit the level of service, Nicoletti says.

3. Educate everyone on your team. If the consultation notes clearly support the criteria, you can rest assured that your coding will resist financial penalties. "But if not, and you want to change your consultation coding, educate everyone about what constitutes a consultation and what documentation a consultation requires," Nicoletti says.

And tell your compliance manager how your coding team has corrected its ways, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J. Have her include in the compliance manual the audit reports and a description of the remedial actions that you took.

Practice Your Consultation Know-How

Before you pull your otolaryngologists' charts, test your auditing skill. See if the following notes qualify as a consultation:

Chart 1: I am seeing this patient at Dr. Jones' request for my opinion about her frequent ear infections. Because of chronic otitis media, I would recommend that the patient have pressure-equalizing tubes inserted in her ears.

Answer 1: These notes support a consultation (99241-99245). The otolaryngologist references the request for an  opinion, renders an opinion, and reports his findings to the requesting physician.

To further show that your office sent a written report to the primary-care physician, check the patient's chart for a letter. If you find a copy, include a parenthetical note stating: See attached letter in front of patient's chart.  

Chart 2: The patient is a 55-year-old male referred to me for treatment of his allergies. I recommend that the patient return in two weeks for diagnostic testing.

Answer 2: This visit qualifies as a new patient office visit (99201-99205), not an outpatient consultation (99241-99245). The documentation shows no request for an opinion.

Chart 3: In a common medical record, an internist writes: I asked Dr. ENT for his opinion on this hospital inpatient for decreased hearing. An entry from Dr. ENT states: After examining the patient and reviewing ordered auditory tests, I recommend that my audiologist evaluate and fit the patient for hearing aids.

Answer 3: The notes support an inpatient consultation (99251-99255). The shared medical record clearly states a request for an opinion and the consultant's findings.