Primary Care Coding Alert

Question: A parent schedules an appointment to show the physician reports on tests conducted on her child, a minor who has had a medical condition that specialists have been trying to control for years. The parent wants our doctors advice on how to proceed and needs a signature to complete further testing. Should this be coded as a consultation? Would it be billed on the childs behalf, or as a consultation with the parent?

Paula Casto
Irving, Texas

Answer: Yes, it is appropriate to assign a confirmatory consultation code (99271-99275), although you may have difficulty receiving payment in this situation. It would be coded and billed with the child as the patient, not the parent.

The situation depicted could be characterized as a second opinion, which is what these codes describe. The codes may be used for adults seeking a confirmatory consultation for themselves or, in the case of a minor, may be conducted with the parent or legal guardian on behalf of the patient. These codes may similarly be assigned in situations where adults are suffering from debilitating conditions that prevent them from making their own medical decisions and where others have been legally assigned this responsibility.

When you assign these codes, the minor patient does not necessarily need to be present. If this is the case, however, the physician must clearly document that the consultative services centered on the patient.

In some situations, the patient might be present for the discussion. However, because the primary reason for the visit is counseling, the history, exam and medical decision-making components of the code might not be met. Coders should remember the physician can rely on time, rather than the key elements, if the counseling comprises 50 percent or more of the visit.