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Thread: Consultations

  1. #1
    Join Date
    Apr 2007

    Default Consultations

    AAPC: Back to School
    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

  2. #2
    Join Date
    Apr 2007


    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

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default 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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