E/M coding is on the rise for radiology - are you prepared? Just a short while ago,
Radiology Coder rarely found themselves in the complex evaluation and management section of the CPT Codes . But these days, if you can't tell a consult from a referral, you could be jeopardizing your practice and your career. Our experts break down the E/M rules every radiology coder must know. Ramp-Up Your 3-R Knowledge Before you code a consult (99241-99275) for your radiologist, scour your report for the Three R's, says Annette Grady, CPC, CPC-H, healthcare consultant with Eide Bailly in Bismarck, N.D., and AAPC National Advisory Board member:
Request by a physician for your radiologist's opinion, recorded in the patient's record. In the hospital setting, when the referring physician and consultant share a medical record, the requesting physician may document the request in his progress note, the medical record, or a separate written request.
Render a service - a formal review, or exam, of the patient.
Report to the requesting physician with your radiologist's opinion and/or advice in writing. In the hospital setting, the report may be an entry in the common medical record. You'll find the Three-R's CMS rule on their Web site at
www.cms.hhs.gov/manuals/104_claims/clm104c12.pdf, section 30.6.10.
Helpful: When coding E/M services, you may choose your code based on time if the counseling/coordination of care constitutes more than 50 percent of the face-to-face encounter between the physician and the patient AND you meet the requirements for consultation, Grady says. Red flag: The key is documentation. The records should show the provider spent X minutes counseling the patient out of a session totaling Y minutes. The provider should also document the topics covered in counseling and describe the coordination of care.
Never: CMS instructs you not to use standing orders for consultations. Instead, you need a distinct request for a consult for each patient before coding and billing this service. Watch for Preoperative Consultations If a surgeon requests that your radiologist perform a preoperative evaluative consultation to determine whether a patient should receive a particular treatment or to assist in choosing among a variety of treatment options, Medicare typically will pay as long as you meet the Three R's AND all the requirements of the code. If your physician doesn't provide medical decision-making (MDM), you can't separately code the pre-op visit.
Example: A gynecologist asks your radiologist for a consultation to determine if a patient is a good candidate for uterine embolization. The radiologist does a thorough history, reviews prior studies, answers patient questions, and performs a physical exam and a pelvic MRI to assist in MDM. Because the gynecologist requests the visit, report a consultation code (99241-99245) for [...]
