White Paper: Consultation Coding For Physicians

By Elin Baklid-Kunz, MBA, CPC, CCS

Consultation coding can be challenging for many physicians, and correct documentation is vital to correctly bill for these services. Many physicians learn about specific consultation requirements only after a third-party payer audit results in the reclassification of their consultations to new patient office visits or subsequent hospital visits. To see how a physician's consultation coding compares with that of other physicians in his or her specialty, review the CMS data on physicians by practice, which shows the E/M codes physicians report most. When a physician's ratio of reporting consultation codes (99241–99245) to new patient office visit codes (99201–99205) is much higher than that of his or her peers, review the requests and documentation for the consultations to determine whether the physician has met requirements.

Recognize increased OIG focus

Remind physicians who have never been audited that CMS expects them to know the regulations related to billing and submitting claims to Medicare and Medicaid. The government outlines its concerns annually in the HHS Office of Inspector General (OIG) Work Plan.

The OIG included consultation coding in the 2002, 2003, and 2004 Work Plans and issued a report in March 2006 highlighting $1.1B in estimated Medicare overpayments made to physicians in 2001 for consultations (a 75% error rate).

Read more...