Pulmonology Coding Alert

Question: A patient originally came to our office based on a referral for a procedure. The pulmonologist subsequently sees the patient for a problem that the procedure manifested. May I report a consult for the subsequent visit?

Maryland Subscriber

Answer: You should code this service as an established patient office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) or as subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...), depending on the setting. Because the subsequent visit is to manage the patient's condition, you should not consider it a consult.
 
Exception: If a physician or nonphysician practitioner requests the subsequent consultative visit, the encounter may qualify as a consultation (99241-99255). The patient's medical record should contain documentation of the request for opinion and the service rendered, and the consulting physician needs to send a report back to the requesting physician.