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Anesthesia Coding Alert

READER QUESTIONS:

Don't Forget 3-Year Rule for New Consults

Published on Wed Mar 22, 2006

Question: A physician in another practice asked our pain specialist to perform a patient consult. We saw her four years ago for an unrelated problem. Can we report a new patient consult code for the visit?


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Answer: Because the other physician requests that your specialist see the patient and offer an opinion on her care, you can bill a consult visit. Choose the appropriate code from 99241-99245 (Office consultation for a new or established patient ...), provided your physician documents the encounter properly: who requested the consultation (and why), a written opinion from your physician regarding his findings, and a written report back to the requesting physician.

The three-year rule explained in CPT's E/M section states that you should consider a patient as "established" if someone in your group sees or treats her within the last three years. Because your group has not seen this patient in four years, you can consider her a new patient.
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