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Specialist Hospital Consultation CPT

Carlos Posted Tue 07th of April, 2020 10:53:03 AM
When a specialist perform a Hospital consultation in a patient we can't use CPT code 99223 since the admitting physician already billed for this. For Medicare which CPT code the specialist has to use in this case?
SuperCoder Answered Wed 08th of April, 2020 11:18:43 AM


Thanks for your question.

Inpatient consultation can be billed for code range 99251-99255. Based on key components (i.e. history, exam and MDM), the level the code should be selected

The provider performs a consultation at the request of another provider. When selecting an E/M service level for an inpatient consultation, there are three key components that must be met in order to report the code appropriately. These components are in addition to the medical necessity for performing the procedure(s).

Hope this helps.


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