Improvement

When to use a consult code

Increase revenue thru proper coding

Coding correctly for consultation increases reimbursement by more than 100% vs. established patient visit codes. That additional reimbursement compensates both for the additional time involved in communicating with the requesting physician and the increased liability involved in rendering an opinion.

Consultation is a response to a request for an opinion by a physician. The request for opinion is specific and requires a response from the consultant. Consultation coding is available to all physicians. Visits with established patients may be coded as consults if the visit meets the criteria.

Although the criteria for coding a consultation are fully elaborated in the CPT manual, a few simple rules summarize the appropriate situation for consultations:

1. Opinion requested by a physician (or entity employing physician)

2. Purpose of exam is to report findings to a physician (or entity employing physician)

3. Only opinion is requested. Treatment of patient is not requested or performed.

Pre-surgical exams performed on a date prior to the surgery are the best example. This is an exam performed for the purpose of providing information to the surgeon (or entity) about the health of the patient in relation to the condition requiring surgery. The primary diagnosis for the service is the surgical diagnosis.

Remember to include the name and NPI of the referring physician with your encounter form. This information is required when billing consults to Medicare. If you do not have the NPI for the referring physician, please list the physician’s name and we will obtain the NPI.

By focusing on proper consultation coding, you can add to your bottom line and compensate for the additional time and paperwork