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Sherry Posted Thu 20th of July, 2017 10:37:39 AM
if a patient has been seen in the office within three years of last office visit can we use a consult code 99241-99245 for a charge or does the decision tree apply to consult codes like new patients codes 99201-99205
SuperCoder Answered Fri 21st of July, 2017 07:57:40 AM


According to CPT, a consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and management of a specific problem is requested by another physician or appropriate source.

if a patient has been seen in the office within three years of last office visit patient considered as established for the physician and established patient codes are appropriate to code.

If, subsequent to the completion of a consultation, the consultant assumes responsibility for management of a portion or all of the patients condition, the follow-up consultation codes should not be used .... In the office setting, the appropriate established patient code should be used. To code consultations following three essential components are required: 

1. the request for an opinion;

2. the examination of the patient and review of medical information pertaining to the case; and 3. the report back to the original physician. If any one of these elements is missing, it is difficult to justify reporting the service as a consultation.

Hope this helps!


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