Urology Coding Alert

Follow the 'R's to success.

Before your providers can get paid for consultations, they must have clear documentation that the requesting physician asked for their services. Remember the five R's of consultations when coding these situations with the old consultation codes:

1. Reason:  With new guide lines for coding with consultation codes only the consulting physicians must document a medically necessary reason for a consultation, and the reason for the consultation must satisfy medical necessity.

2. Request: The request must come from another physician or qualified nonphysician practitioner (NPP). CPT^® also allows requests from other appropriate sources, so check with your payers to determine what they consider valid consult request sources. For compliance, the consultant should verify the request from a requesting source in his medical records.

3. Render: The consultant must render services during which he may initiate diagnostic and/or therapeutic services.

4. Report: The consultant must issue a written report of his findings, advice and opinions to the requesting source.

5. Return (recommended by consultants): To show that a transfer of care didn't occur, the consultant should eventually send the patient back to the referring physician.

"As most payers are not using consultation codes, use instead the E/M service codes for office and hospital visits as explained above," advises Michael Ferragamo MD, FACS, clinical assistant professor of urology, State University of New York. "Also remember that the above mentioned criteria for consultations will not be required and are not part of the E/M codes that you now use for consultative services. However, even though these criteria are not mandated for billing purposes, you may want to document some to show good medical care even though consultation codes will be rarely documented."