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Question regarding 3 year rule for consult billing

Ivonne Posted Fri 23rd of October, 2009 16:03:36 PM

I need clarification , Can we bill an new consult for a medicare patient that has been seen before the 3 years??? exp: patient seen in 2008 DX 715.15 came back in 2009 with new Dx: 354.0 can we bill a consult????/

SuperCoder Answered Tue 27th of October, 2009 11:45:03 AM

The consultation codes 99241-99245 and 99251-99255 are described as "Office or Other Outpatient Consultations - New or Established patient" and "Inpatient consultation - New or Established Patient" respectively. These codes apply to both new and established patients as long as the three R's (Request, Recommendation and Report) are met. Since the patient here has come for a new problem under request from another physician the consultation codes can be used.

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