Urology Coding Alert

Question: One of our doctors stopped at another doctors office to see a patient. He is trying to charge a consult visit (99241). We are in Shreveport, La. This doctors office is in Minden, La., and does not have an association with our office. Would we be able to charge the visit, and if so, what would I charge as the location?

Dea Denmon
Regional Urology, Shreveport, La.

Answer: A consultation requires three elements: (1) request by a provider, (2) seeing the patient, and (3) writing a letter back to the requesting provider. If all three elements were met, then you can use the consultation code. The location code is office. Alternatively, it could be that this was your physicians patient and remember that you can bill a consultation on an established patient if the three elements are fulfilled.

For example the patient became suddenly ill while visiting his mother in Minden. This patient is uncomfortable with any doctor other than your physician. The patient calls and requests your physician to visit him in another doctors office. In this case, you would code an office visit (99212-99215), any procedures done, and finish with 99056 (services provided at the request of a patient in a location other than physicians office which are normally provided in the office). Unfortunately, although this is correct CPT coding, 99056 will not be paid by Medicare. And you may have to fight for it with commercial payers.