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Consults 99254-55 & 99244-45

  1. #1
    Loma Linda
    Red face Consults 99254-55 & 99244-45
    Medical Coding Books
    Can someone help with me with this. the provider i bill for he asked me if you can use consults codes-99254-55 & 99244-45 be used within a 30 day period even if location changes: outpatient to inpt or 1 hospital to another. does he bill for follow up codes or can he bill for another consultation codes since the patient has moved. From what i read that you may bill for another consultation code if the patient is in a different facility or being seen for another problem not releated to the first consultation request. Any other information would be big help.

    Help me


    Sarah M., CPC

  2. #2
    You can only bill a consult if you meet the requirements, ie another request for opinion would be necessary to charge another consult.

    If your provider is consulted on an inpatient then has the patient follow up with him outpatient, you bill established codes.

    Place of service is only an issue on the inpatient side for medicare (and carriers that follow medicare guidelines), you can only have 1 consult per stay per provider regardless of how many requests you get.

    Laura, CPC

  3. #3
    I agree with Laura.

    In addition: Once the patient has been seen and is seen again without a request for an opinion, then it is an established patient/subsequent care.
    It is possible for the same patient to come for another consult - meeting the requirements of request, recommendation, report back - for the same problem, too. For example, the patient has a chronic condition and your specialist sees the patient and gives the recommendation to the requesting provider, who treats the patient. After a period of time the provider requests that your specialist takes another look at the patient to see if the treatment (previously recommended) is working or if there are new recommendations. However, if the treating provider after several months* decides you should treat the patient from this point forward and both are clear on that, then it is a transfer of care and should be billed established.
    Always ask why was the patient here - for (f/u) care or opinion at the request of another provider?
    *I used "several months" as an example.

  4. Default Consult Code 99254
    Will this apply to Medicaid as well? Any information on this will help greatly..

    Thank you In Advance

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