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Thread: Consultation vs E & M

  1. #1

    Default Consultation vs E & M

    AAPC: Back to School
    I have a patient who was referred to us by her PCP for Post Menopausal Bleeding. Our doctor did an exam & a endometrial biopsy. In addition to the biopsy, should I code E & M or 99243 consultation? In this case the PCP's office actually made the appointment & our Dr. corresponded back to the PCP so I am leaning towards the consultation code. In general, what is the rule for distinguishing between E & M and office consultations (99214-99244)? I know that if the visit is initiated by the patient we need to go with an E & M code. Other than that I am confused. Thanks!

  2. #2
    Join Date
    Apr 2007
    Evansville Indiana

    Default consult

    Under the new CPT definition of consultation, if the patient is not Medicare, it would qualify as a consult, As long as your MD was asked for an opinion on the patient. You may want to read the CPT guidelines for consults in the 2010 book. (They changed the definition)

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