Results 1 to 6 of 6

consultation codes

  1. Smile consultation codes
    Clearnace Sale
    There is a physician who doesn't want to charge a consultation if he has been requested to consult on an established patient of his that is in the hospital. He wants to charge a subsequent visit instead. He feels that since he has seen patient for the same problem/ similar problem in the last two weeks, month, etc, than he doesn't feel right charging a consult/ intial visit( based on insurance carrier and the ruling for medicare and consultation). I understand his point of view. However, the intent of the requesting physician was for him to do a consultation. Setting aside the new rule from Medicare regarding consultation and that there is no distinction between new patient and established for inpatient, wouldn't this still have to be coded as above and not subsequent hospital visit. Just wanted to get some feedback on this. Thanks in advance!


  2. #2
    Columbia, MO
    I agree with the physician, it is not a consult his logic is good.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    If it is for a NEW problem that he has not seen the patient for previously, then he should bill a CONSULT, if it is an established problem they have discussed previously, it should be a SUBSUQUENT visit.

  4. #4
    From reading your post, I understand that the doctor feels if the patient is an established patient for a non medicare he does not want to bill a consultation but a follow up visit. In an inpatient setting does he also want to bill subsequent care codes instead of 99251-99255. Does he also want to bill subsequent care codes for Medicare patients instead of billing 99221-99223 for their initial hospital care?

  5. #5
    Columbia, MO
    I am confused... it really does not matter what a provider wants to bill what matters is does it meet the requirements of a consult. From the information posted, estb patient, estab dx, then this is not a consult by definition. This is why I agree with the physician.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Thanks for all of your help. Yes, he wants to bill a subsequent visit 99231-99233 instead of a consult regardless of the payer if it's an established patient of his that is in the hospital when he is called to consult on.


Similar Threads

  1. Consultation codes
    By skoch65 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 02-02-2012, 02:11 PM
  2. Consultation Codes - medical decision making
    By chodges in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 10-06-2010, 01:55 PM
  3. Consultation codes
    By AuditU in forum E/M
    Replies: 2
    Last Post: 02-01-2010, 10:57 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.