Urology Coding Alert

Question: An ER doc refers a patient to our office for a kidney stone. Can we charge for a consultation? Is there any difference in that the referring physician is an ER doc versus any other specialized doctor?

Nevada Subscriber

Answer: A patient referred to you from the emergency room (ER) is never a consultation. You should bill these patient visits using the new patient E/M codes (99201- 99205, Office or other outpatient visit for the evaluation and management of a new patient ...). If your urologist has seen the patient in the past three years, instead report an established patient E/M code (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...).

Why: When an ER physician refers a patient to your office for treatment of a condition, such as a kidney stone,  your urologist will not return the patient to the ER doctor for follow-up care. Your urologist won't likely send a consultation report back to the ER physician either. You must meet both of those criteria to be able to bill a consultation code (99241-99245, Office consultation for a new or established patient ...). In the above scenario your urologist is not returning the patient to the requesting physician and he isn't reporting back to that doctor with his opinion on the patient's condition.