Consultation codes can be billed only if all the three below criteria are fulfilled in documentation:
- Requesting physician’s name and indication for the request of consultation
- Full documentation of consulting physician’s services and findings
- Findings, assessment, suggestions, tests ordered, reports etc. as result of the consultation is communicated back to the requesting providers.
- If your documentation meets all three of the above criteria, report a Consultation Service Code.
- If thd documentation is missing any of these criteria ( or your payer does not accept Consultation Codes), report an Outpatient Office Visit or Inpatient Office Visit
This encounter is not reported separately when: Telephone service ends with a decision to see the patient within 24 hours or next available urgent visit appointment. (encounter is considered part of the preservice work of the subsequent E/M service, procedure, and visit.)
Telephone call refers to an E/M service performed and reported by that individual within the previous seven days (either requested or unsolicited patient follow-up) or within the postoperative period of the previously completed procedure, then the service(s) are considered part of that previous E/M service or procedure. (Do not report 99441-99443 if reporting 99441-99444 performed in the previous seven days.)
Online digital E/M services are reported once for the physician's or other other health care professional's cumulative time devoted to the service during a seven-day period. The seven-day period begins with the physician's or other QHP's initial, personal review of the patient-generated inquiry. Physician's or other QHP's cumulative service time includes review of the initial inquiry, review of patient records or data pertinent to assessment of the patient's problem, personal physician or other QHP interaction with clinical staff focused on the patient's problem, development of management plans, including physician- or other QHP generation of prescriptions or ordering of tests, and subsequent communication with the patient through online, telephone, email, or other digitally supported communication, which does not otherwise represent a separately reported E/M service. All professional decision making, assessment, and subsequent management by physicians or other QHPs in the same group practice contribute to the cumulative service time of the patient's online digital E/M service. Online digital E/M services require permanent documentation storage (electronic or hard copy) of the encounter.
(For online digital E/M services provided by a qualified nonphysician health care professional who may not report the physician or other qualified health care professional E/M services [eg, speech-language pathologists, physical therapists, occupational therapists, social workers, dietitians], see 98970, 98971, 98972).
This encounter is not reported separately when: the consultant has seen the patient in a face-to-face encounter within the last 14 days. the telephone/Internet consultation leads to an immediate transfer of care or other face-to-face service (eg, a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant.
The majority of the service time reported (greater than 50%) is not devoted to the medical consultative verbal/Internet discussion. This service is already reported once within a seven-day interval. the sole purpose of the telephone/Internet communication is to arrange a transfer of care or other face-to-face service.
- Select carrier locality to get RVU and Fee schedule for specified state. By default, "National" is selected, for which the Fee and RVU values will be calculated on “Final Code Level “screen unless otherwise specified.
(Do not report 90791 or 90792 in conjunction with 99201-99337, 99341-99350, 99366-99368, 99401-99444)
(Use 90785 in conjunction with 90791, 90792 when the diagnostic evaluation includes interactive complexity services)
Codes 90791, 90792 are used for the diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day.