Radiology Coding Alert

Question: If we see a patient in our office for a consult six months after we saw her for a separate consult, can we code the later visit as a consult, too?

Florida Subscriber

Answer: As long as you meet the requirements for coding a consult, you may report more than one consult for this patient.

CPT: According to CPT 2009, "If an additional request for an opinion or advice regarding the same or a new problem is received from another physician or other appropriate source and documented in the medical record, the office consultation codes may be used again."

CMS: The Medicare Claims Processing Manual, Chapter 12, Section 30.6.10, includes the same instruction and adds 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."

Radiologists may consult for patients with abnormal mammograms and breast ultrasounds or with leg pain at rest, for example. Radiologists typically don't provide continuing services to patients, so this limitation usually does not apply to repeat radiology consultations.

Note that both CMS and CPT indicate that you may report a second consult even if both visits are for the same diagnosis.

Caution: You should not report a second consult during the same inpatient admission, however.