How to determine the consultation Service


A consultation is a type of service provided by a medical provider whose advice regarding a specific problem is requested by another provider. It can be requested by another member of your group who has special expertise (such as ADHD). It is not a transfer of care. It cannot be requested directly by the patient or family member.

Four requirements: 

 1. There must be a request. The person receiving the request should state who made the request.
2. There must be a statement as to the reason for the request.
3. The service must be provided
4. A written report must be sent to the referring physician. Internally, the note is sufficient.

CPT Coding (There is no difference between a new or established patient)

                99241 (requirements of a 99201 visit)
                99242 (requirements of a 99202 visit)
                99243 (requirements of a 99203 visit)
               99244 (requirements of a 99204 visit)
               00245 (requirements of a 99205 visit)

Coding based on time of the visit

If more than 50% of the face to face time of the visit is spent in counseling, time may determine the level of the visit. The codes below are for the total time of the visit.

                   99241 15 minutes
                   99242 30 minutes
                  99243 40 minutes
                  99244 60 minutes
                   99245 80 minutes

ICD-9 Coding Consultations There are no specific does for a consultation. They should be coded as to the problem that the consultation was requested for. Do not use preventive health codes (V70.0, etc.)

For pre-op exams this the ICD-9 codes in this order:

                        V72.83 Other specified pre-operative exam
                        XXXXX The condition for which the operation is necessary
                        XXXXX Any other diagnoses that came up during the exam

Resident Coding 

Residents are restricted to the following CPT codes: 99201, 99202, 99212, 99203 or 99213 UNLESS the supervising physician performs, or is physically present, during the key or critical portions of the service provided. This must be documented in the note by the supervising physician. That means, for a resident to billing a level 4 or 5, the supervising physician must physically exam the patient. While it may seem easier to only bill a level 2 or 3, the resident, and FHCW, is telling a third party payer that the resident saw no complex patients. For a resident to bill according to time, the supervising physician must be present for the entire time spent in counseling.

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