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Coding for prolonged service during a face-to-face encounter (consultation)

Carol Posted Mon 03rd of October, 2011 20:04:35 PM

Our physician sees a new patient during a lengthy consultation in gastroenterology. In addition, he offered 1/2 hour of face to face counseling on the patient's diagnosis. I have submitted copies of the doctor's consultation and documentation for the counseling but it is still not paid for. What are we doing wrong?

SuperCoder Answered Tue 04th of October, 2011 05:08:29 AM

Check if the insurance is Medicare. Medicare doesn't pay for consultation codes.

Carol Posted Tue 04th of October, 2011 14:37:13 PM

I am well aware that Medicare does not pay for consult codes. This patient has a commercial insurance and they are still denying the claim for prolonged service. What documentation is necessary to get this paid.

SuperCoder Answered Tue 04th of October, 2011 18:33:25 PM

May I know which cpt codes you used?

Carol Posted Tue 04th of October, 2011 21:10:18 PM

Established patient seen last two years ago code 99215 with 99354 and documentation stating counseling for diagnosis Thank you

Nikhil Answered Tue 04th of October, 2011 21:30:27 PM

Codes are correct. Submit with Letter of Appeal.

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