Orthopedic Coding Alert

Question: If I perform an office consultation on a patient, how much time must elapse before I can bill 99241-99245 again for the same patient?

Florida Subscriber

Answer: CPT and Medicare don't restrict how often you can report an office consultation for the same patient. You should bill 99241-99245 (Office consultation for a new or established patient, which requires these three key components ...) if the visit meets a consultation's three criteria.
 
An appropriate source, such as another physician, must request your physician's opinion regarding the patient's condition. The orthopedist must render the examination and then report his findings to the requester in writing.
 Suppose a family practitioner requests your physician's opinion on a 16-year-old female who possibly has scoliosis. Your orthopedist evaluates the patient and issues a report to the family physician. You code the visit with 99244.
 
Six months later, an urgent care clinic sends the same patient to you. The clinic performed an x-ray to evaluate a possible wrist fracture and asks for your opinion. You may report a consultation for this visit as well, even though the consultations occur within the same six months.
 
If an insurer denies or downcodes the consultations for frequency, contact the Florida Department of Insurance and report the payers' activities. Florida imposes fines on payers that downcode 99241-99245 to 99212-99215 (Office or other outpatient visit ...).