Primary Care Coding Alert

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 family physician's opinion regarding the patient. Your FP must render the examination and report his findings to the requestee in writing.

Suppose a school nurse requests your FP's opinion on a 15-year-old male with failing grades and suspected drug use. Your FP evaluates the patient and issues a report to the school nurse. You code the visit 99244.

Four months later, the adolescent requires that his wisdom teeth be removed. Due to the patient's heart murmur, the oral surgeon requests your FP's opinion on whether the patient is fit for surgery. 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.