Consultation frequency

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2
Location
Jones Creek, TX
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I am looking to find some guidance in how many times may a provider bill a consultation code? I have patients that well known to the practice and every time they go to the hospital my provider wants to bill a consultation code. Any documentation to this nature would help.
 

Chelle-Lynn

True Blue
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729
Location
Modesto, CA
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You should report an inpatient consultation code (99251-99255) for initial consultation services provided in the hospital, nursing home or partial hospitalization settings only once per admission, according to CPT. If you are consulted more than once during the patient's same admission, your subsequent consultations should be reported with the subsequent hospital care codes (99231-99233) or nursing facility services codes (99307-99310).
 
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811
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You also have to make sure the initial encounter meets the criteria for what's considered a "consultation" - Basically, did it meet the 3 R's?
 
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