Request for Consult

Question: It is routine for surgeons to call our office to request a preoperative cardiac risk stratification consult prior to a planned surgery or other consults. Our front desk gathers the information, makes a log note in our electronic medical record, and then schedules the patient. Can this count as the “written” request for a consult or must we request a formal written request to be able to bill for a consult? If there is no written record of the request, we routinely defer to calling the visit a “new patient.”

Answer: Yes, the called-in physician request counts.

Medicare officially stated several years ago that a physician could report a consultation code for a preoperative clearance if all the requirements of a consult are met - the consult was requested by another provider and a written report is supplied to the physician who requested the consult. The consultation code can be reported even for an encounter with an established patient. The American Academy of Family Physicians (AAFP) published an informative article on the subject once Medicare clarified its rules.

In September 2002, the AAFP clarified: “Family physicians do most of these services at the request of a surgeon, who is usually seeking the family physician’s opinion on whether the patient is fit for surgery. If you document this request in the patient’s medical record (e.g., “Ms. Jones seen at the request of Dr. Smith, who is requesting preoperative clearance due to X”) and provide a written report to the requesting surgeon, you should be able to report these preoperative visits using a consultation code. If the service is done in the office, use an office consultation code (99241-99245); if it is provided in the hospital, use an initial inpatient consultation code (99251-99255).

In either case, choose the level of service based on the level of history, exam, and medical decision making involved, since all three key components must be met to code a given level of consultation.”

As far as ICD-9 coding goes, first report the appropriate V-code for preoperative clearance (V72.81-V72.84). Next, list codes representing why the surgery is necessary, and finally, list any other conditions.