Pediatric Coding Alert

Question: A surgeon asked a pediatrician for pre-op anesthesia clearance on a new patient. How should I report this service?

New Jersey Subscriber

Answer: You could report a consultation (99241-99245, Office consultation for a new or established patient ...) provided the encounter meets the service's requirements:

1. The surgeon made a verbal or written request for the pediatrician's opinion on the patient's ability to withstand anesthesia. Your physician's documentation should include this request.
2. The pediatrician examined the patient and determined his suitability for undergoing anesthesia.
3. The pediatrician sent a written report detailing his findings to the surgeon. If the surgeon sent you a form for the pre-op anesthesia clearance, you can count the completing and returning this form as the report.

A level-two consultation pays approximately $28 more than a level-two new patient office visit. Code 99242 (... which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision making ...) contains 2.50 relative value units ($95), whereas 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires  these 3 key components: a expanded problem-focused history; a expanded problem-focused examination; and straightforward medical decision making ...) has 1.74 RVUs ($67) using the 2008 Medicare Physician Fee Schedule that some private payers follow.