Pulmonology Coding Alert

Question: While covering for one of my colleagues on an old existing case, a new pulmonary problem arises. As an internist, I could bill for a follow-up visit (99231). My colleague wants me to be a pulmonology consultant on the new problem. Should I bill this patient as a new consult or continue to bill as a follow-up?

Delaware Subscriber

Answer: Whether a consult may be billed depends on the documentation in the medical record. The three Rs must be covered before its correct to bill for a consultation: request, review and report.

We presume from the question that the problem occurred while you were covering this case, that you informed the colleague, and the colleague requested your opinion or advice on the condition. To be paid for a consultation (99241-99275), the request must be documented in the patients medical record and your written opinion or advice must be given to the requesting physician. If the documentation is not sufficient to bill for a consultation (i.e., request in the record and written opinion), the subsequent-day code (99231) would be appropriate.

Also, if the colleagues intent and documentation is a referral for treatment or management of the condition rather than a request for your opinion or advice, the subsequent-day code is appropriate.