Urology Coding Alert

Bonus: Palmetto GBA gives concrete consult answers

When your urologist sees a patient at the request of another physician, you'll turn to the consultation codes (99241-99245). If you automatically rule out a consultation code when your urologist provides treatment, you need to re-evaluate your coding practices.

Myth buster: Your urologist can provide treatment after seeing a patient in consultation as long as there is no "transfer of care." A transfer of care occurs when the referring physician transfers the responsibility for the patient's complete urological care to the receiving physician (your urologist) at the time of referral. If there is a transfer of care, depending on the situation, you should report a new or established patient visit (99201-99215) rather than a consultation code.

Get a Carrier's Perspective

One carrier issued a new "frequently asked questions" item on consults. A provider asked

Palmetto GBA a straight question, and Palmetto gave a straight answer.

The question: Can a provider start additional testing or treatment at an initial consultation and still have the visit considered a consult?

Palmetto's answer: Yes. A physician or qualified nonphysician practitioner can start diagnostic services and treatment at the initial consult or at a subsequent visit. But you shouldn't bill for "ongoing management" after the first consult using consultation codes. Instead, you should bill for later visits using the subsequent visit codes.

Palmetto does include one cryptic sentence at the end: "Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs." And Palmetto doesn't define "transfer of care."

Nonetheless, the Palmetto clarification is helpful, say experts. "Anytime physicians initiate treatment, they are still in OK territory to bill a consult," says Quinten Buechner, MS, MDiv, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, with ProActive Consulting in Cumberland, Wis.

The Medicare Claims Processing Manual (Chapter 30) says that a transfer of care is an agreement between two doctors for the specialist to take over the patient's care, Buechner says.