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consultation codes

  1. Smile consultation codes
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    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!

    Paula

  2. #2
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    Columbia, MO
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    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
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    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
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    Columbia, MO
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    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.

    Thanks
    Paula

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