Ob-Gyn Coding Alert
Stop Counting Your Ob-Gyn's Consults
Question: How often can we report consult codes for the same patient? We saw a patient in July for a consult, and then the ob-gyn saw her again for another consultation in October. Can we bill both consults?
Florida Subscriber
Answer: The outpatient consultation codes (99241-99245) do not have frequency restrictions, and the patient does not need to present with a new problem for you to use an additional consultation code.
According to CPT, -If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again.-
Typically, when a patient returns for an additional consultation, she has a problem that is unrelated to the original complaint or has a progression of the original problem. If the physician performs an additional consultation for a given patient, be sure the documentation includes a detailed explanation for the subsequent consultation(s).
Follow this rule: Medicare policy (Medicare Claims Processing Manual, Chapter 12) states that -if the consultant continues to care for the patient for the original condition following his/her initial consultation, repeat consultation services shall not be reported.- So be absolutely sure that the physician requested a second consultation and that your documentation reflects this correctly.
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