Billing consult and preventive code with office visit

A consultation is an evaluation of a patient provided by a physician at the request of another physician or appropriate source. The consulting physician may order tests or therapeutic services at the time of the visit, and these would be reported separately. The request for the consultation as well as the consultant's opinion must be documented in the patient's chart. A written report must be sent back to the physician requesting the consult. A consultation requested by the patient or family member and not by a physician or appropriate source should not be reported with consultation codes. Report the appropriate evaluation and management (E/M) code for this service.


If an abnormality/ies is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office/outpatient code 99201-99215 should also be reported. Modifier -25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided by the same physician on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.

A problem/abnormality encountered in the process of performing the preventive medicine evaluation and management service that does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported.

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