Urology Coding Alert

A patient may be referred to a urologist several times for different reasons. Urology coders frequently wonder if they can bill a consultation for each visit. The answer is yes, providing that all of the criteria for a consultation are met.

The scenario: Lets say a patient comes in to discuss various options for sexual dysfunction, such as impotence, ICD-9 code 302.72. The patients primary-care provider requested the urologists opinion and advice, the urologist documented the request in the medical record and after meeting with the patient, the urologist sends a report back to the primary-care physician. That visit meets all the requirements of a consultation. Then, lets say the patient is referred to the urologist again, six months later, for dysuria (788.1 or 306.53). Again, the primary-care provider requested the urologists opinion and advice, the urologist documented the request in the medical record and after seeing the patient the urologist sends a report back to the requesting physician. New patient (99201-99205), established patient (99211-99215), or consultation (99241-99275)?

The coding: Consultation, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and reimbursement consulting firm in Denver, Colo. Theres no limit on the number of consultations that can be provided as long as the expert is being asked for his or her opinion.

And it doesnt have to be for a new problem, says Page. For example, if the urologist recommended a treatment course that was administered by the referring physician, and the patient showed no signs of improvement at the end of the course of treatment, the referring physician may request another consultation to re-evaluate the patient, she says. However, she adds that it is more likely that the referring physician would transfer the care of the patient to the consultant for management of the problem after review of the report.

(The exception here, notes Page, would be inpatient consultations99251-99263. Only one initial consultation is allowed per hospitalization. Additional consultations during the same hospitalization would be reported with the follow-up inpatient consult codes.)

Finally, Page stresses that an essential element of a consultation is that the requesting physician review the consultation report even though the urologist may have already initiated treatment.