Wiki Consultation Codes

[scaddell]

Hello,

I was wondering if there were any higher level consultation codes other than the 99243 that can be billed for a patient where extensive time was involved. Maybe an add on code that I'm missing? Thanks in advance!

 

[Orthocoderpgu]

Hello,

I was wondering if there were any higher level consultation codes other than the 99243 that can be billed for a patient where extensive time was involved. Maybe an add on code that I'm missing? Thanks in advance!

Are you sure you are coding an actual "consultation"? These are very rare. I would make that my starting point to verify that an actual consultation was performed.

 

[sjooemmy08]

I use 99245 for the consultation with my neurologist. He does take a full amount of time to see the patients as well as to examine the condition to the fullest extent.

 

[csperoni]

Consultation codes may be billed based on time (face to face time if >50% in counseling/coordination of care, NOT 2021 outpatient total time definition), assuming the 3Rs of consultation have been met, and the carrier accepts consultation codes.
Medicare did away with consultation codes about 10 years ago due to their findings of abuse/overuse that the actual requirements of consultation were not met. Almost all commercial payors have followed suit. As a result, many practices don't even use consult codes anymore.
Only if you meet the consultation requirements and only if the carrier accepts consult codes should you even consider 99441-99445 & 99551-99555. I cannot stress this enough. If those requirements are met, then you may use consult codes and bill either on history, exam & MDM or face to face time if >50% in counseling/coordination of care.

 

[Orthocoderpgu]

I use 99245 for the consultation with my neurologist. He does take a full amount of time to see the patients as well as to examine the condition to the fullest extent.

Look at Christine's answer. That is what I was referring to. A consultation has three separate requirements. You miss one of those requirements and you no longer have a "consultation" you then have an E/M. Since 95% of the time, according to a three year audit by CMS, those three requirements were not met, which is why I said that consultations are very rare. All I am saying is to make sure you have met the three requirements for a consultation before you bill a consultation code, and if so, does your patient's insurance still consider that code for benefits?