Pulmonology Coding Alert

Question: We are a small pulmonary practice, and we often refer patients to a local allergist. The allergy practice faxes us a consult request form every time we send a patient to him -- even when we transfer care of the patient to the allergy practice. Is this necessary?


Illinois Subscriber

Answer: The only time the allergist will need to send your practice the consult request form is when one of your pulmonologists specifically asks the allergist to perform a consultation but fails to put his consult request in writing. In those cases, the allergist can send your practice the form to ensure that you've authorized a request for consult, and not merely a transfer of care.

If you simply refer a patient to the allergist -- meaning your pulmonologist transfers the patient's care to the allergist--then from a coding standpoint, there is no need for a written request of the referral. In fact, if the allergist asks you to fill out the consult request form every time you refer a patient, there is a chance that he is actually billing the visits as consults (99241-99245) and not as new or established patient office visits (99201-99215). If that is the case, he may be misrepresenting the intent of the visits.

Bottom line: If you always send your consult requests to the allergist in writing, you shouldn't need to fill out the consult request form because you've already provided a written request for the service.