Question: When Can We Use Consultation Codes?

What is the CPT code for consultation?

Consultations for Medicare patients are reported with new patient (99201–99205) or established patient (99212–99215) Current Procedural Terminology (CPT) codes.

For non-Medicare patients (unless otherwise instructed by a payor), office or other outpatient consultations are reported with codes 99241–99245..

What is considered a consultation?

An office consultation is a service rendered by a physician whose opinion or advice regarding a specific problem or condition is sought by another physician. The physician requesting the consultation generally continues to manage the patient’s care following the consultation.

What is the difference between referral and consultation?

A consultation is a request from one physician to another for an advisory opinion. … A referral is a request from one physician to another to assume responsibility for management of one or more of a patient’s specified problems.

What does CPT code 99204 mean?

CPT code 99204: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity.

What happens during a new patient visit?

Your physician will take a complete history, perform a physical, and may recommend testing to be done that day. Some appointments are purposefully set up to only accomplish a consultation and testing will be performed on a separate date, especially for drug and stinging insect allergies.

What’s a consultation appointment?

This consultation appointment will give you a chance to meet with the therapist, help to define what the issues are, and decide whether therapy is the right course of action for you at this time. If, together with the therapist, you decide to proceed, you will be offered a series of mutually agreed appointments.

What is a new patient consultation?

Inpatient Consultation New or Established Patient: The initial inpatient consult codes are used the first time you are asked for your opinion during that hospital stay. You may only report one initial consultation code during the patient’s admission for either you or your group partner in the same specialty.

How do I code an inpatient consultation?

You should report inpatient consultation services using an Initial Hospital Care code (99221-99223) for the initial evaluation, and a Subsequent Hospital Care code (99231-99233) for subsequent visits.

What does CPT code 99243 mean?

CPT® 99243, Under New or Established Patient Office or Other Outpatient Consultation Services. The Current Procedural Terminology (CPT®) code 99243 as maintained by American Medical Association, is a medical procedural code under the range – New or Established Patient Office or Other Outpatient Consultation Services.

What is a consultation report?

The consultation report is used to convey findings and opinions of a healthcare provider other than the patient’s primary physician. The consultant assesses the patient’s current condition and needs and then suggests or confirms a treatment plan. … Primary care physicians often call on specialists as well.

When did Medicare stop paying for consult codes?

January 1, 2010As of January 1, 2010, Medicare will no longer recognize for payment CPT consultation codes.

What are the requirements to bill a consultation?

CPT® defines a consultation as “a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.” To substantiate a consultation service, documentation must include three elements: a request, a …

Does Medicare pay for inpatient consultation codes?

Answer: Medicare stopped recognizing and paying consult codes, but consults are still requested and provided to inpatients every day. … The citation from the Medicare Claims Processing Manual is at the end of this Q&A. Many commercial insurance companies still recognize consults.

How do you code ER visits?

CMS defines the two very differently and coders report different codes depending on the location. For Type A EDs, coders use CPT codes 99281–99283 with status indicator V (clinic or ED visit) and codes 99284–99285 with status indicator Q3 (codes that may be paid through a composite APC).

Are CPT codes used in hospitals?

As part of the Omnibus Budget Reconciliation Act in 1987, CMS mandated use of CPT for reporting outpatient hospital surgical procedures.

What are consult codes?

The guidelines for use of the consultation codes simply indicate that use of these codes requires that one physician is responding to a specific request for opinion/advice from another physician regarding evaluation and/or management of a specific problem.”

What are the 3 R’s for consultation?

The “Three R’s of Consultations” include documentation of the request, rendering of the service and report back. The report should be some formal communication to the requesting professional.

What is the CPT code for intraoperative consultation?

For an intraoperative consult use codes 99251 through 99255 (initial inpatient consultations) or 99241 through 99245 (office or other outpatient consultations), based on the documentation, and the request from the other surgeon must be in the patients chart.