Radiology Coding Alert

Question: How specific must a consult request be? I know there must be a specific reason for the request, but does the request have to specify by name the interventional radiologist who should provide the consult? Georgia Subscriber Answer: Although a requesting physician certainly may request a consult from a particular specialist, this isn't required. Neither AMA nor CMS guidelines state that the consultation request must specifically name the physician who will provide the consult. Theoretically, as long as the request specifies the problem, any physician with the expertise to provide his opinion may provide the consultation service. The requesting physician might send a patient only to a particular practice, for instance, rather than to an individual physician, for a consultation. Remember: To report a consult service, your interventional radiologist must meet all the requirements for that code set. He must document the following, at least: request from a qualified healthcare provider reason for the consult rendering the consult service reporting back to the requesting provider. If your physician does not meet these requirements, you should report an office visit code (99201-99215). Also keep in mind that if the patient's primary-care physician merely stated that the patient should see an interventional radiologist, that would more likely be a transfer of care rather than a consult, and you would likely code for an office visit.