Pulmonology Coding Alert

Question: Our pulmonologist performed a consultation in our office with an arthritic patient who was in treatment with a rheumatologist and we ended up taking over the patient’s care due to her having pulmonary fibrosis. How can we bill the consultation?

Missouri Subscriber

Answer: You can report 99241-99245 (Office consultation for a new or established patient ...) if your pulmonologist takes over treatment of the condition and the payer recognizes these consultation codes. But reporting a code from this range does not assume a transfer of care. It is possible that the patient would still see the rheumatologist for her arthritis and would see your practice for the pulmonary fibrosis. Either way, the intent of the original visit is still that of a consultation.

Remember: To bill a consultation code, you need to ensure your provider’s documentation includes the following criteria:

• Reason for consult
• Request for your doctor’s opinion
• Rendering the service in order to develop an opinion (the consult visit)
• A written or auto-generated letter to the requesting doctor with the opinion of the rendering provider
• Return the patient once the course of treatment is complete

Check with your payer: If you are billing Medicare or another payer that no longer recognizes the consultat ion codes, then you cannot collect for these codes for the consultation. The intent of the visit doesn’t change, however, and you should report a new or established office/outpatient E/M visit code depending on the patient’s status with the group practice of the consulting physician.