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General Surgery Coding Alert

Reader Question:

99241-99255: Keep Consults When Possible

Question: Can we still use "consult" E/M codes?North Carolina SubscriberAnswer: The answer to that question depends on the payer. If your insurer accepts the codes, then yes, you can continue to use E/M consult codes.Starting in 2010, Medicare discontinued recognition of the consult codes 99241-99255 (Office or other outpatient consultation ...). Some payers continued to accept these codes, however, and CPT® maintained the codes in 2011 and again in 2012. Opportunity: You shouldn't stop using the consult codes if your payer accepts them. The codes pay 40 percent more than other E/M codes that have comparable levels of history, physical exam, and medical decision-making.Do this for Medicare: For Medicare and insurers that follow the same rules as Medicare for consults, you should choose one of the following codes for an E/M service that would qualify as a consult, depending on outpatient or inpatient status:99201-99205 -- Office or other outpatient visit for [...]

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