Radiology Coding Alert

Question: A medical oncologist has a patient in his practice with small cell lung cancer. The medical oncologist refers the patient to a radiation oncologist for an opinion and, subsequently, five weeks of radiation therapy to the lung mass. After radiation therapy is completed, the patient is discharged by the radiation oncologist and only seen in follow-up by the medical oncologist.

One year after completion of radiation therapy, the patient presents to the medical oncologist with headaches. A scan is done which shows the lung cancer has metastasized to the brain. The medical oncologist asks the same radiation oncologist to deliver an opinion about treating the patient with radiation therapy to the brain. Should the radiation oncologist bill this visit as a consultation as this is a new problem, or should he bill it as an established patient visit as he has seen this patient in the past?

Anonymous N.Y. Subscriber

Answer: According to Linda Lively, MHA, president and CEO of American Medical Accounting and Consulting in Marietta, Ga. (a firm that has specialized in coding, training and auditing for radiation oncology practices for more than 16 years), any patient who returns to a consulting physician for an opinion at the request of the attending physician should be coded as a consultation from the 99241-99245 section of the CPT for outpatients (new or established patients), or the 99251-99255 for inpatients (new or established patients). If the follow-up visit is initiated by the consulting physician, then it should be reported as an office visit code rather than a consultation (99211-99215, established patient; office or other outpatient visit).

Basically, it revolves around who initiated the request and the transfer of care. Coders should note that a consultation does require a written request and a written response from the consulting physician, says Lively.