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Consultation

Darshna Posted Mon 27th of February, 2017 12:28:44 PM
I work for an Orthopedic surgeon and when he goes to Hospital he does consultation with patient and they decide to do surgery after consultation. What CPT code should we use for consultation?
SuperCoder Answered Tue 28th of February, 2017 07:53:18 AM

Hi,

  • Consultation, as defined by the CPT manual, is an evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem, or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem.

  • Consultations can only be billed out when requested by another physician or appropriate source.

  • A consultation requested by a patient is not reported by using consultation codes rather, it is reported by using the appropriate E/M code.  A patient requesting a second opinion or a consultation does not meet the CPT definition of a consultation code.

  • Consultations for Medicare patients are reported with new patient (99201–99205) or established patient (99212–99215) Current Procedural Terminology (CPT) codes. For non-Medicare patients (unless otherwise instructed by a payor), office or other outpatient consultations are reported with codes 99241–99245. Consultation codes are only appropriate if the patient is referred by another provider for consultation; otherwise, new or established patient codes are used

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