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Consult Codes

Tierni Posted Fri 15th of May, 2020 19:00:06 PM
I know many insurance companies no longer accept consult codes, but for the ones that do; is it appropriate to bill a consult code if the provider had a phone conversation with the patient as long as the provider's documentation supports it?
SuperCoder Answered Mon 18th of May, 2020 15:43:00 PM

Hi Tierni,

Thank you for your question.

It is appropriate to bill a consult code if the provider had a phone conversation with the patient as long as the provider's documentation supports it. Also, POS 02 must be used in claim form for telemedicine services and append modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to an appropriate CPT code.

FYI: The totality of the communication of information exchanged between the provider and the patient during the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components of the same service when rendered via a face-to-face interaction. Codes must be listed in Appendix P of the CPT book.

NOTE:

Telemedicine: “A two-way, real- time interactive communication between a patient and a physician or practitioner at a distant site through telecommunications equipment that includes, at a minimum, audio and visual equipment.”

Feel free to ask for any further query.

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