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outpatient hospital

Janice Posted Mon 27th of February, 2017 12:54:06 PM
what is the consult code for outpatient hospital and also observation code for outpatient hospital consult for a patient the doctor has never been seen in the office thanks
SuperCoder Answered Tue 28th of February, 2017 02:55:15 AM



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 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.



Consultation services in OBSERVATION STATUS are reported with the outpatient consultation codes (99241–99245).



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Thank you!

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