Consultations

becca12

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Idaho
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I have a question about consultations. My surgeon did a consultation for one of my physicans on a patient that they thought need surgery. In the exam the surgeon just went over her past medical history and he consulted with the physican that sent her. The surgeon did not do an exam but he came up with some non-surgical recommendations. I billed a consultation but another physican is questioning my decision because the surgeon didn't do an exam. So can you bill a consultation when a provider doesn't do an exam but meets with the patient, and goes over the patients past medical history with the patient in the room? If you can't bill a consultation what do you recommend me to bill?

Thanks in advance
Rebecca
 

LLovett

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Unless time was documented, you can't bill a consult code based on what you are saying. They are based on 3 of 3 (history, exam, medical decision making) so no exam, no charge.

But, if 3 vitals were taken and recorded that would be 1 element of exam and could qualify for a level 1.

Laura, CPC
 
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Location
Milwaukee WI
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Time based

If your physician recorded the total time spent face-to-face with the patient, and that more than 50% of this total time was in counseling/coordination of care (which it sounds like it was) ... you could choose your level of consult based on time.

For Office / Outpatient Consult
15 minutes - 99241
30 minutes - 99242
40 minutes - 99243
60 minutes - 99244
80 minutes - 99245

For Inpatient Consult (floor/unit time = face-to-face for inpatient)
20 minutes - 99251
40 minutes - 99252
55 minutes - 99253
80 minutes - 99254
110 minutes - 99255

F Tessa Bartels, CPC, CPC-E/M
 
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