For coding purposes, when is a patient who is new to your office an office consultation as opposed to a new patient?

April 8, 2007

Excerpts from Q&A sessions that followed the coding sessions at the Urology Congress

Please define who is a new patient in your office as opposed to an office consultation for coding purposes?

"A patient who is new, for coding purposes, is a patient you have never seen nor have your associates or partners ever seen," Dr. Ferragamo explained.

An existing patient whom you or your partner have not seen for 3 years and who comes back with a different problem, he can be billed as a new patient. The code for a new patient pays significantly more than billing for an established patient, Dr. Ferragamo pointed out.

In a consultation, your opinion and advice are sought by another physician and you have not been contacted by the requesting physician in advance to take over treatment. A consult can be your decision to take over the patient from a referring physician as long as it happens after seeing the patient.

Can you bill for a radiography reading in the office after it has already been read by a radiologist?


The short answer is no. CMS will only allow one paid reading of film. You cannot bill for reading the film if somebody else has already read that same film, Dr. Ferragamo said.

Whatever reading you do, you must document it. It must be very similar to what you would expect the radiologist to do.

"I would start off talking about the size of the urethral catheter you used, the type of catheter, how much contrast you injected, and what contrast you used, and go on to give a full radiology report. You can put it on the procedure report, but I would advise you to tell the transcriptionist, 'new paragraph: radiological findings,' then dictate what you did and what you found," he said.

I received a patient from a gynecologist, the husband, for a vasectomy. Is that a consultation or a new patient?


If that patient comes in for a vasectomy, the OB/GYN does not likely want a response back from the urologist.

"The only time I would bill a consultation under those circumstances is if, for some reason, I don't want to do the vasectomy, then I send a letter back to the OB/GYN saying that in my opinion, he should not have a vasectomy. That's the consultation. But when he comes in for a prevasectomy visit and counseling, I would put that down as a new patient visit," Dr. Ferragamo said.

Let's say that a physician in a large practice sees a renal mass and sends the patient to his partner, who is the laparoscopic specialist in the office. How is that handled?


The answer depends on your intent when you send that patient to your partner. If you are sending that patient to your partner for the expressed purpose of a laparoscopic nephrectomy, then the patient is considered an existing patient. If, however, the expressed purpose is to an obtain an opinion from the partner about whether laparoscopic surgery is appropriate, then it would a be a consultation. Dr. Ferragamo said.