When is it appropriate to use consultation codes?
The guidelines for use of the consultation codes simply indicate that use of these codes requires that one physician is responding to a specific request for opinion/advice from another physician regarding evaluation and/or management of a specific problem."
How to setup a CPT code?
How To Setup A CPT Code. From the Office, Billing or EMR Product tab: Expand the Search folder. Select Code to open the Code Search Screen. From the Health Care Codes section on the Claim Screen: Put the cursor in the procedure code field. Select the Ctrl button and the Q button on the keyboard to open the Code Search Screen.
How to use CPT code 99214 correctly?
How to use CPT CODE 99214 Correctly? To get reimbursed properly, you need medical billing and coding experts who are aware of all these details along with documentation requirements or simply you ...
How to apply for a new CPT code?
- Submission of a current, complete and materially compliant application form and all other necessary supporting documents
- Adherence to all posted deadlines
- Full cooperation with requests from CPT staff and/or Editorial Panel members for clarification and information
What does CPT code 99241 mean?
CPT® Code 99241 - New or Established Patient Office or Other Outpatient Consultation Services - Codify by AAPC. CPT. Evaluation and Management Services. Consultation Services. Office or Other Outpatient Consultation Services.
What is the CPT code for Office consultation?
Office or Other Outpatient Consultation Services CPT® Code range 99241- 99245. The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Consultation Services 99241-99245 is a medical code set maintained by the American Medical Association.
What is the CPT code for consult and treat?
99241 CPT Code Description Office and other outpatient consultation service codes describe the physician seeing the patient upon the request of the primary care provider regarding diagnosis and treatment or determination to accept the transfer of care of a patient.
What is a consultation code?
A consultation code may be billed out for an established patient as long as the criteria for a consultation code are met. There must be a notation in the patient's medical record that consultation was requested and a notation in the patient's medical record that a written report was sent to the requesting physician.
What is the CPT code for initial consultation?
Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) are still active CPT® codes, and depending on where you are in the country, are recognized by a payer two, or many payers.
Can you bill a consult with a procedure?
In addition to admissions, discharge and daily patient care, hospitalists also perform consultations, prolonged services and bedside procedures, and must bill appropriately for these additional services. Physicians can select the appropriate Current Procedural Terminology (CPT) codes to bill for these services.
What is an office consultation?
An office consultation is a service rendered by a physician whose opinion or advice regarding a specific problem or condition is sought by another physician. The physician requesting the consultation generally continues to manage the patient's care following the consultation.
Is 99214 a consult code?
According to CPT, 99214 is indicated for an “office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity.” [For more detailed ...
How do you bill a hospital consultation?
If a social worker or therapist asks for your clinical opinion, bill that encounter using one of the initial hospital care codes (99221-99223). If another physician has already performed a history and physical for the admission, use a subsequent care code (99231-99233).
What is CPT code 99213 used for?
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes.
What does CPT code 99223 mean?
Initial hospital careCPT 99223 is defined as: Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history. A comprehensive exam. Medical decision making of high complexity.
What is the CPT code 99211?
CPT® code 99211 is defined by the 2011 CPT Standard Edition manual as: "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.
What is a 99244 office consultation?
99244 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem (s) and the patient’s and/or family’s needs. Usually, the presenting problem (s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.#N#Level 4 Office Consult (99244)
What is a consult?
A. consultation initiated by a patient and/or family, and not requested by. a physician, is not reported using the initial consultation codes but. may be reported using the codes for confirmatory consultation or office. visits, as appropriate.
How long does it take for BCBSNC to replace a code?
BCBSNC will replace a code billed for a subsequent office or other outpatient consultation within 6 months of the initial office or other outpatient consultation by the same provider for the same member with the appropriate level of established office visit. The crosswalk is as follows:
What is CPT code 99241?
type of service (CPT codes 99241-99275) provided by a physician whose#N#opinion or advice regarding evaluation and/or management of a specific#N#problem is requested by another physician or other appropriate source. A#N#physician consultant may initiate diagnostic and/or therapeutic#N#services.
Does Medicare accept 99241?
Medicare no longer recognizes consultation CPT codes 99241-99245 and 99251-99255. This applies for both Medicare-primary and Medicare-secondary claims. Please Note: These codes are still valid CPT codes for 2010, and Blue Cross continues to accept these consultation codes.
What is the CPT code for inpatient consultation?
Inpatient consultations are reported with CPT″ codes 99251-99255. The codes are used to report physician or other health care professional consultations provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting.
How many times can an inpatient consultation be reported?
The initial inpatient consultation may be reported only once per consultant per patient per facility admission. 2. In the office or outpatient setting, the consultant should use the appropriate office or outpatient consultation CPT″ codes 99241-99245 for the initial consultation service. 3. A consulting physician or other qualified health care ...
Who may initiate diagnostic services and treatment at the initial consultation service?
3. A consulting physician or other qualified health care professional may initiate diagnostic services and treatment at the initial consultation service or may even take over the patient’s care after the initial consultation.
What is consultation in medical terms?
According to CPT 2006, a consultation is a "type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.".
What is CPT modifier 32?
CPT modifier -32 is intended to identify cases in which a consultation was mandated by entities such as a third-party payer, government agency, or regulatory requirement. When deemed appropriate, the modifier would be appended to the basic procedure performed. According to CMS, the use of modifier -32 has no effect on reimbursement.
Is a consultation a consultative service?
A consultation requested by a patient or family would not be reported as a consultative service. However, it may be reported using another applicable E/M service code such as an office visit code.
Can a consultation E/M code be reported?
Therefore, even if practitioners are of the same specialty, if the requirements for a consultative service are met, a consultation E/M code may be reported. Documentation, however, must be clear that the advice or opinion of another practitioner is needed and being sought.
Does CPT limit consultation codes?
According to the April 2000 CPT Assistant, "CPT does not limit the use of the consultation codes according to whether or not the physician providing the consult service is of a different specialty field than the physician requesting the advice or opinion.
Can physicians report E/M?
Physician offices may report E/M services with either guidelines on a case-by-case basis or choose one for all E/M services provided. The decision of which guidelines to employ may be an important one to the facility's practitioners. For that reason, a comparison of the E/M level achieved based upon one set of guidelines compared to the other, ...
Is a consultation a shared or split?
According to CMS, current payment policy precludes a consultation from being a "shared/split" service. It is felt that a consultation is a unique E/M service not performed jointly or as a team. It may be decided by an NPP and physician to share or split a consultation service; however, this service must then be billed using the NPP's UPIN/PIN, not the physician's UPIN/PIN. The physician may bill the consultation under his or her UPIN only when all components have been performed by the physician.
