Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

Billing Clinical Consultation Services - 80500, 80502
Clinical consultations are paid under the physician fee schedule only if they:
a. Are requested by the patient’s attending physician;
b. Relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient;
c. Result in a written narrative report included in the patient’s medical record; and
d. Require the exercise of medical judgment by the consultant physician.
Clinical consultations are professional component services only, i.e., there is no TC service. The clinical consultation codes are 80500 and 80502.
Routine conversations held between a laboratory director and an attending physician about test orders or results do not qualify as consultations unless all four requirements are met. Laboratory personnel, including the director, may from time to time contact attending physicians to report test results or to suggest additional testing or be contacted by attending physicians on similar matters. These contacts do not constitute clinical consultations. However, if in the course of such a contact, the attending physician requests a consultation from the pathologist, and if that consultation meets the other criteria and is properly documented, it is paid under the fee schedule.
EXAMPLE: A pathologist telephones a surgeon about a patient’s suitability for surgery based on the results of clinical laboratory test results. During the course of their conversation, the surgeon asks the pathologist whether, based on test results, patient history and medical records, the patient is a candidate for surgery. The surgeon’s request requires the pathologist to render a medical judgment and provide a consultation. The pathologist follows up his/her oral advice with a written report and the surgeon notes in the patient’s medical record that he/she requested a consultation. This consultation is paid under the fee schedule.
In any case, if the information could ordinarily be furnished by a nonphysician laboratory specialist, the service of the physician is not a consultation payable under the fee schedule.
See the Program Integrity Manual for guidelines for related data analysis to identify inappropriate patterns of billing for consultations.
Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Its often confused that BCBS have lot of prefixes and where to contact. However we have some guide to follow, using prefixes we could find t...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...
-
procedure code and description 90832 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes with t...
-
Lucrative career opportunities for medical billing specialists When you think of large hospital networks, the first picture that comes to ...
-
BCBS COMM PA PO BOX 890062 CAMP HILL, PA 17089 866-763-3608 BCBS NORTHEASTERN COMM PA PO BOX 890062 CAMP HILL, PA 17089 800-829-8599 ...

No comments:
Post a Comment