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Sandeep Posted Fri 27th of October, 2017 06:58:26 AM
How often can the consult codes be billed in office, asc, and hospital settings?
SuperCoder Answered Mon 30th of October, 2017 06:06:30 AM



Outpatient consultation guidelines

  • The outpatient consultation codes (99241-99245) are used to report consultations provided in the office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, or emergency department. For the new patient consultation can be billed once only. For subsequent consulation visits the patient will be considered as established and appropriate codes from established patient visit will be coded.
  • 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).

Inpatient consultation guidelines

Only one consultation should be reported by a consultant per admission. Subsequent services during the same admission are reported using subsequent hospital care codes.

Hope this helps!

Sandeep Posted Wed 01st of November, 2017 07:56:41 AM
Hello, My question is about frequency i.e once in 23 months. Is it applicable to outpatient, office, and inpatient as well.
SuperCoder Answered Thu 02nd of November, 2017 07:44:18 AM


CPT codes e.g. annual visits, preventive medicine services are biiled once in a year. But, the E&M service codes (consultation, outpatient, inpatient, emergency, etc.) are regular visit codes, hence they are billed as per visit codes.

As stated above these codes (consultation) are per visit codes so it has nothing to do with frequency. Therefore, frequency fundamental of once in 23 months is not applicable to outpatient, office, and inpatient settings.

Hope this helps!

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