Coding Question - 99244 vs 99214

[Kim Friend]

Can anyone help me with this issue? I work for a Pulmonary/Sleep Study doctor. The doctor reads a sleep study and codes a 95811-26. He may then see the patient and codes the visit as a 99244 as this is a new patient to him. I am being told by one source that I need to change the visit to a 99214 because the patient is considered established because he "read" the report. Another source tells me that is incorrect and I should bill the 99244.

What is the most correct way to code this scenario?

 

[Laureen]

99244 is a consult code so does the documentation support a request for opinion and a report back to the requesting physician of that opinion?

 

[Kim Friend]

99244 is a consult code so does the documentation support a request for opinion and a report back to the requesting physician of that opinion?

It does. So if Doctor wants to charge the 99244 we should send notes along with charge?

 

[Laureen]

No you don't have to send documentation unless requested. It's just our job as coders to make sure "what is reported can be supported" Often physician say it is a consult when the documentation doesn't support it. So we have to do physician education to protect them in case of an audit and to prevent them from commiting fraud - even if "by accident".