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Thread: Consultations- Do we need the consult request

  1. #1

    Default Consultations- Do we need the consult request

    AAPC: Back to School
    Since Medicare will no longer be accepting consult codes and we are to use new or established patient codes, do will still need to have a consult request from the specialist? Seems like it would be a waste of time if we're not using the consult codes. Since we won't be using consult codes for Medicare can we just do away with consult codes on all of our payers. Our consults are mostly pre-ops for surgery.

  2. #2
    Join Date
    Apr 2007
    Swainsboro/Statesboro, GA

    Default CPT Guidelines

    I would continue to follow the CPT guidelines for non-medicare patients, until I was instructed otherwise from specific payers.

    As you have probably already read, there is not a direct crosswalk from the 5 levels of consult codes to the 3 levels of admission codes. Coders are already planning how to educate their providers on the additional documentation requirements of the history and exam for the low level of 99221 (detailed or comprehensive) vs. the existing 99241 or 99251 (problem focused).
    Freda Brinson, CPC, CPC-H, CEMC
    2014 President AAPC Swainsboro, GA Chapter
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

  3. #3


    With this change, will the documentation/billing be specific to the e&m or will there be a carry-over from the consultation guidelines from Medicare? Example: listing the requesting physician on the claim as well as the medical record?

  4. #4


    We have been instructed by several Medicare MAC contractors that it we be no longer necessary to have the referring doctor on the claim...it's only needed as part of the medical record documentation
    ~Ursula, CPC~

  5. #5
    Join Date
    Apr 2007


    I am personally recommending at my practice that we continue to code consults to the commercial carriers until we are notified of their termination of such codes therefore, we continue to adhere to the CPT guidelines for commercial carriers. Just my 2 cents.

  6. #6


    if you're billing non-Medicare cases, since the amount paid is much higher for corresponding consult levels, it seems that you could lose some money by switching to regular office visit codes in place of consult codes (ie. 99241 to 99201) (pssst: I think Medicare eliminated the codes primarily for that reason!)

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