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Wiki Consults

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candygirl160

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The Savannah, GA Chapter
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A pt was seen in 2008 for a consult. Pt comes back in 2010 to the same provider's office for another consult BUT saw another provider and it is a different problem than in 2008. Can we bill a new pt consultation for provider #2 since the pt is coming in with a new problem?
 
If it is a true Consultation request from another provider, for a different body part, and your Doctor is sending a letter back giving his recommendation, then yes absolutely.

Jenna, CPC, ACS-EM
 
Definition of a new pt code is a patient who has not received a professional
service(E&M or other face to face) within the past three years with the same
physician or another physician in the same specialty - same group. The new problem is not a factor.
 
consult

If this is commercial insurance, there is no distinction between a new patient consult and an established patient consult (99241-99245). If a physician has asked an opinion on a new problem and it meets the other criteria for a consult, then that is what I would bill. If not then you would have to bill an established patient office visit (99212-99215).
If it is Medicare, you would have to bill an established patient office visit.
 
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