Coding: Consult or no consult?

Q: An allergist sends a patient with pain, tenderness, and swelling around their cheeks and nose to the otolaryngologist for a consult. The ENT determines the patient has an acute exacerbation of their chronic rhinosinusitis and needs prescription management, as they have experienced several rhinosinusitis exacerbations throughout the year. After the two physicians discuss patient management, the allergist decides to follow the otolaryngologist’s recommendations regarding drug therapy.

A: This case could qualify as moderate complexity for the problem management; since one chronic illness with exacerbation was addressed, data falls into the moderate level, as there was discussion of management with an external physician and prescription management, which places the risk in the moderate level.

The provider met moderate complexity in all three areas, even though two areas would have sufficed, which means that the appropriate consultation code is 99244 (Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded).

Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.