General Surgery Coding Alert

Question: Can we still use "consult" E/M codes?

North Carolina Subscriber

Answer: The answer to that question depends on the payer. If your insurer accepts the codes, then yes, you can continue to use E/M consult codes.

Starting in 2010, Medicare discontinued recognition of the consult codes 99241-99255 (Office or other outpatient consultation ...). Some payers continued to accept these codes, however, and CPT® maintained the codes in 2011 and again in 2012.

Opportunity: You shouldn't stop using the consult codes if your payer accepts them. The codes pay 40 percent more than other E/M codes that have comparable levels of history, physical exam, and medical decision-making.

Do this for Medicare: For Medicare and insurers that follow the same rules as Medicare for consults, you should choose one of the following codes for an E/M service that would qualify as a consult, depending on outpatient or inpatient status:

• 99201-99205 -- Office or other outpatient visit for the evaluation and management of a new patient ...
• 99211-99215 -- Office or other outpatient visit for the evaluation and management of an established patient ...
• 99221-99223 -- Initial hospital care ...
• 99231-99233 -- Subsequent hospital care.