Radiology Coding Alert

Question: How often can we report consult codes for the same patient? We saw a patient in September for a consult, and then the radiologist saw her again for another consultation in March. Can we bill both consults?


Florida Subscriber

Answer: The outpatient consultation codes (99241-99245) do not have outlined restrictions on their frequency of use, and it is not necessary for the patient to present with a new problem for an additional consultation code to be appropriate.
 
According to CPT 2006, "If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again."

Typically, when a patient returns for an additional consultation, he has a problem unrelated to the original complaint or has a progression of the original problem. If the physician performs an additional consultation for a given patient, be sure the documentation includes a detailed explanation for the subsequent consultation(s).

Rule: Medicare policy (Medicare Claims Processing Manual, Chapter 12) states that "if the consultant continues to care for the patient for the original condition following his/her initial consultation, repeat consultation services shall not be reported."

A radiologist doesn't typically provide services to the patient on a continuing basis, so this caveat does not usually apply to repeat radiology consultations.