Pulmonology Coding Alert

When a physician sends your pulmonologist a patient for an initial visit involving a specific problem, you can lock down the requester's intent with this form.

Does the requester want your physician's opinion, or is he transferring the care of the patient's problem to your pulmonologist? The answer can make the difference between a consult and a new patient office visit -- and more reimbursement for the practice, because consult codes pay more than E/M codes 99201-99205.

Here's the standard consultation request form that Patricia A. Trites, MPA, CHBC, CPC, EMS, CHCC, CHCO, CHP, CEO of Healthcare Compliance Resources in Augusta, Mich., maintains on file from the requesting physician. If neither of these options represent the intent of the request, the service is not a consultation:

Dear Dr. ______________,

It is our understanding that you have requested Dr. ________________ to perform a consultation on your patient, _______________________, for the following condition, symptoms or problem:______________________________________.

As you know, the definition of consultation has been changed by CMS, and we must now ask your intention regarding this patient.

Would you like us to (please mark the appropriate box below):

Provide an opinion only regarding the evaluation and/or management of this patient's condition

Provide an opinion regarding the evaluation and/or management of this patient's condition as well as treat the patient for this condition

We have appointed this patient on (date and time) ____________________________.

Please fax this completed form back to our office at _______________ as soon as possible. In addition, please forward to our office any necessary medical records that you believe are pertinent for the evaluation of this patient's condition.