Pediatric Coding Alert

Question: I recently saw a patient who'd been seen six months before by another member of my pediatric group who has since left. The child's parents requested a second opinion on the prognosis for their child, who had cystic fibrosis. I performed an extensive multisystem exam, reviewed the lengthy medical record and spent 75 minutes counseling the parents. Should this patient be coded as a new patient?

South Carolina Subscriber

Answer: This service meets the definition of a confirmatory consultation (99271-99275). The patient's parents requested the physician's opinion of an established diagnosis. Because another physician did not request this service, the standard consultation codes should not be reported. The physician providing this service may evaluate the patient and provide an opinion based on his or her evaluation, but may not institute any diagnostic or therapeutic interventions. In keeping with current documentation guidelines for consultations, a written communication must be sent to the party requesting the consult, in this case the patient's parents.

In the families of E/M codes, consultation codes often reimburse the most and are usually appropriate for children with chronic medical conditions. Review the CPT consultation guidelines before billing these codes.

The answer to the Reader Question was provided by Richard Tuck, MD, FAAP, practicing pediatrician with Primecare Pediatrics of Zanesville, Ohio.