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Pediatric Coding Alert

You Be the Coder:

Do Consults Still Apply?

Question: In volume 14, issue 11 of Pediatric Coding Alert, you advised a practice regarding a patient who had visited a physician six months ago, and then was referred back recently for a new condition. You advised that the patient should be billed with an established patient office visit code (99211-99215) because they had seen your physician previously within the past three years. However, it's possible that a consultation code could apply instead since another physician referred the patient back to you recently for a separate problem. Can you clarify?New Jersey subscriberAnswer: If your payer still accepts consultation codes and your documentation meets the requirements of the consult code series 99241-99245, you should report a code from that range instead of an office visit code.Keep in mind: CMS stopped recognizing consultations in 2010; therefore, most Medicaid programs will not accept these codes, and some other private payers have followed suit. However, [...]

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