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Billing Consult Codes

Tierni Posted Wed 10th of August, 2016 17:08:00 PM
It appears that the 99241-99245 codes can be applied to new "or" established patients, if there is a consultation request from another physician in the chart. Does this mean that we can use consult codes for follow-up patients, if there is a referral from another physician for a problem unrelated to their previous visits? Our physician sometimes see this - a patient was seen/treated for something, and then the next year (still within the 3 year 'new patient' fence) their Doc will send another referral requesting reevaluation. Is this a situation where consultation codes could be used again??
SuperCoder Answered Thu 11th of August, 2016 03:54:27 AM

Greetings from SuperCoder!  

Follow-up visits in the consultant's office or other outpatient facility that are initiated by the consultant or patient are reported using the appropriate codes for established patients, office visits (99211-99215), domiciliary, rest home (99334-99337), or home (99347-99350).  

But if an additional request for an opinion or advice regarding the same or a new problem is received from another physician or other appropriate source and documented in the medical record, the office consultation codes may be used again.  

Thanks.

Tierni Posted Thu 11th of August, 2016 12:02:27 PM
When you say..."if an additional request for an opinion or advice regarding the same or a new problem is received from ANOTHER physician or other appropriate source and documented in the medical record, the office consultation codes may be used again". What if it's from the same physician? Example, Dr. Jones refers to Dr. Smith in 2013 for a problem. Then in 2014 - Dr. Jones refers to Dr. Smith "again" (reevaluation) for the same patient, with the same problem. Could a consult code be used again?
SuperCoder Answered Fri 12th of August, 2016 03:04:26 AM

Hi, please note that "another physician" means the physician other than the consultant who is providing consultation to the patient.

In your example, if Dr. Jones refers to Dr. Smith in 2013 for a problem and then in 2014 - Dr. Jones refers to Dr. Smith "again" (reevaluation) for the same patient, with the same problem. Consult codes can be used again.

Thanks.

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