Pulmonology Coding Alert

Question: If another physician asks our pulmono-logist to evaluate and manage a new patient's (not our patient) chronic obstructive pulmonary disease (COPD), is it a consult? I know we cannot bill a consult for our COPD patients, but what about a new patient?

Illinois Subscriber

Answer: If the primary-care physician (PCP) feels that he or she cannot manage the patient's medical condition, care of the patient may be transferred to a pulmonologist. In the question's example (the outpatient setting), the pulmonary physician will report one of the new patient service codes (99201-99205).

If the PCP asks for the pulmonologist's opinion regarding the evaluation and management of a specific problem, however, this constitutes a request for a consultation. Consequently, the pulmonologist should perform and report a consult (99241-99245).

The request and medical necessity for a consult must be documented in the patient's chart. The pulmonologist rendering the consultative service must send a written report of his or her findings to the requesting physician (the PCP), and the pulmonary physician should maintain a copy of the report for his or her records.

Also, when rendering a physician-requested consult, the consulting pulmonologist may institute diagnostic or therapeutic interventions. If the consultant initially evaluates the patient e.g., provides and reports a consult and then a transfer of care occurs (the PCP turns over total management of this problem to the consultant), subsequent visits to the physician consultant should be reported using the established patient E/M codes (99211-99215).