Radiology Coding Alert

Question: A patient was referred to our radiology practice to evaluate their heart metabolism. The patient came in for an initial consultation on a PET scan of their heart before the procedure the following week. The physician spent one hour with the patient discussing the patient’s medical history, the procedure, and the doctor’s opinion.

Do I code the visit using 78459 or is there another more applicable code?

Alabama Subscriber

Answer: For this situation, you will only need to use 99244 (Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.), which is the appropriate evaluation and management (E/M) code.

According to the CPT^® manual, “Preliminary consultation, evaluation of patient prior to decision to treat, … may be identified by the appropriate procedure codes from Evaluation and Management, Medicine, or Surgery sections.” Since the procedure for the PET scan (78459 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study) was only discussed with the patient in the visit, there isn’t a need to document the procedure.

You’ve indicated the physician spent 60 minutes with the patient going over their medical history, the procedure, and the physician’s thoughts on the procedure. Additionally, for this visit to be billed as a consultation, the following items need to be recorded:

• A written or verbal request for the consultation in the patient’s medical record by the requesting or consulting physician.
• The consultant’s opinion as well as any services that were ordered or performed in the patient’s medical record.
• A written report of the consultant’s findings, opinion, or recommendation that is returned to the requesting practitioner.

Modifier note: If the consultation is required, such as by a third-party payer, then you will append the CPT^® code with modifier 32 (Mandated services).