Wiki Consult codes in office setting

[EricaApostol]

I work in ENT, sometimes our Doctors want to bill consult codes for new patients they see in the office. (99242, 99243, 99244). It was my understanding that consult codes in office are generally not paid but we are getting conflicted information from payers. They are inconsistent where some have paid and some have not.

Does anyone have any advice on trying to bill for these and can we?

 

[jkyles]

Hi there, you'll need to check with each plan you accept because it is up to each private payer whether they'll cover them. The only hard and fast rule is that Medicare does not cover them and has not since 2010.

I recommend creating a spreadsheet so everyone understands when a consult will and will not be covered.

 

[NRaizman]

Make sure, as well, that consultation reports are sent to the consulting provider, otherwise it does not count and can be clawed back.