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Pediatric Coding Alert

You Be the Coder:

CPS Request? Code a Consultation

Published on Sun Aug 22, 2004

Question: Some of my pediatricians see child protective services (CPS) clients for preplacement exams. CPS refers these patients to us, and the pediatricians see them specifically for the exam. Should I code these as consultations?

Texas Subscriber

Answer: You can bill these services as consultations, but you must be sure that you meet all of the standard requirements for a consultation - including a  verbal or written request for the consultation/exam from the CPS.
In addition to the request for consultation, be sure that the pediatrician fully documents the elements of the exam and that he sends a written reply back to the requesting organization regarding his assessment of the child. If you do not have documentation of all of these elements, you may only report a new patient visit (99201-99205, which has a lower relative value amount for payment).

For more information on coding consultations, see the CMS guidelines at www.cms.hhs.gov/manuals/14_car/3b15000. Be sure to read section 15506 on consultations.
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