Member Tip: Confused About Consultation Codes?

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  • In Coding
  • November 13, 2009
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Confused about the Evaluation and Management Consultation codes in CPT® 2010 (99241-99255)?  Didn’t Medicare just say that, save for HCPCS Level II codes for telehealth consultation, they were out the window? (See “2010 MPFS Final Rule Still Holds Surprises,” EdgeBlast No. 136.) So why are they in the official CPT® code book? Is it a mistake, and if not, does that mean commercial payers are reimbursing for them?

It’s no mistake, says Sheri Bernard, CPC, CPC-H, CPC-P, vice president, clinical coding communications, AAPC. “The codes remain in CPT® 2010 with expanded official guidelines that iden­tify scenarios that in the past would not have been consid­ered consultations,” according to Bernard. 

Check with payers to whom you report these codes to find out if they are reimbursing them and for what services specifically. Unfortunately, at this point no one really knows what all the payers will think of these codes now.

AAPC former NAB member Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, is asking colleagues to contact her with what payers in their states say they will accept come Jan. 1, 2010. She will compile the data into a spreadsheet and make it available via the AAPC Web site.

If you’d like to contribute information to this project, and help Cobuzzi clear the confusion with her grass-roots project, send what you’ve learned about payers in your area to her in an e-mail (

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