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Thread: Consults

  1. #1
    Join Date
    Apr 2007
    Location
    The Savannah, GA Chapter
    Posts
    6

    Default Consults

    Promo: Code Books
    A pt was seen in 2008 for a consult. Pt comes back in 2010 to the same provider's office for another consult BUT saw another provider and it is a different problem than in 2008. Can we bill a new pt consultation for provider #2 since the pt is coming in with a new problem?

  2. #2

    Default

    If it is a true Consultation request from another provider, for a different body part, and your Doctor is sending a letter back giving his recommendation, then yes absolutely.

    Jenna, CPC, ACS-EM

  3. #3
    Join Date
    Apr 2007
    Location
    Modesto California
    Posts
    70

    Default

    Definition of a new pt code is a patient who has not received a professional
    service(E&M or other face to face) within the past three years with the same
    physician or another physician in the same specialty - same group. The new problem is not a factor.

  4. #4
    Join Date
    Apr 2007
    Location
    Evansville Indiana
    Posts
    451

    Default consult

    If this is commercial insurance, there is no distinction between a new patient consult and an established patient consult (99241-99245). If a physician has asked an opinion on a new problem and it meets the other criteria for a consult, then that is what I would bill. If not then you would have to bill an established patient office visit (99212-99215).
    If it is Medicare, you would have to bill an established patient office visit.

  5. #5
    Join Date
    Apr 2007
    Location
    Evansville Indiana
    Posts
    451

    Default consult

    Sorry, I should have added that they would be established if the providers are of the same specialty, if not you could bill a new patient.

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