Pre-op/consult

[Carin]

My family practice physician sent an established patient to see an orthopedic for knee pain. The othopedic physician determines that surgey is necessary and sent the patient back to us for a pre-op for medical clearance. What is the correct E&M code to use? An established office visit or a consultation code. I know we can not bill a consult code per CMS but what about regular insurances?

 

[Naveen Rachagolla]

For CMS if it is out patient consultations used office visit codes and for in patient use inpatient admission codes 99221 - 99223.

If patient has other insurances and if they accept the normal consultant codes then used 99241 -99255 based on the appropriate category.

FOR CMS - In your case your physician will bill the normal establised pt code 99211 - 99215 and the orthopedic will bill the code from 99201 - 99215 with modifier 57 and and aslo there should be appropriate consultant documentation signed by the docs

For other than CMS bill with regular consultant codes 99241 - 99255