Pulmonology Coding Alert

A consultation is a request for an opinion or for advice. There are three criteria, also known as the Three R's, that your physician must satisfy for a consultation. Be sure your pulmonologist satisfies each of these three criteria before you submit a consultation code:

First, a qualified medical professional must request the consultation. This request can come from anyone who is qualified to order the service, such as the physician, physician assistant, or nurse practitioner, and the patient's chart much include a notation about the request. Without a specific, documented request from another medical professional, you can't use a consultation code. A specific written order for a consultation from the requesting physician is not necessary, but a statement of this fact should appear in the medical records.

Second, the consulting physician needs to record his findings, opinions, and advice in written form in the patient's medical record.

Finally, the consulting physician must submit a written report to the requesting physician. Both the requesting physician and the pulmonologist should keep a copy of this report.