Outpatient consult or New E/M

I am seeing a new HCV patient in my infectious disease practive who is sent by thier PCM for evaluation and treatment. Do I code the initial eval as a consult (99241-5) or a New Pt (99201-5)?

New patient

Evaluate and treat is a new patient visit (99201-99205).

Consult or new patient

This is why many of us in the coding world agree with CMS: get rid of the consult codes and all of this ambiguity.

The question isn't whether you end up treating or not: you may bill a consultation if you order diagnostic tests or initiate treatment. There are two questions to consider:

1) Are you being asked to evaluate, assess, or provide an opinion because you have expertise in the area. I think we all would say yes. The INTENT of the visit is for you to provide an assessment.

2) Is care being transferred to you for this condition, or will you and the PCP share in the care of the patient for this condition? That one is probably harder to answer. I audit literally thousands of PCP notes each year, and I often find that they are continuing to participate in the care of patients with other specialists. If care is being transferred to you, then it is a new patient. If you and the PCP will share in the patient's management, a consult.

This is the crux of CMS's proposal to eliminate payments for consults (There is an article called "no more consults" in Codapedia). They believe that the physician community has never accepted the idea of transfer of care equaling a new patient.