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Pediatric Coding Alert

Reader Questions:

Don't Accept Consultation Frequency Limits

Published on Sun Aug 22, 2004

Question: Does a time limit exist on how long must pass before I can bill 99241-99245 on 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 ...) as long as the visit meets a consultation's three criteria. An appropriate source, such as another physician, must request your pediatrician's opinion regarding the patient. Your pediatrician must render the examination and report his findings to the requesting practitioner in writing.

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.
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