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Thread: Consult without Physical Exam

  1. #1

    Unhappy Consult without Physical Exam

    AAPC: Back to School
    Our surgeon did a consult note on a patient he was asked to render an opinion on. The patient was not seen, however every point of documentation required for a consult was completed except for the actual physical exam where the surgeon noted "physical exam was not performed since the consultation was requested based on evaluating her clinical history and angiography".
    Is there a CPT code I can use to describe this service? or Do I just not bill for this service since the physical exam was not done? I am not sure how to approach this.
    Thanks for your help!

  2. #2
    Join Date
    Apr 2007


    The dr is entitled to be paid..what about using the unlisted 99499 with explanation and report sent to the carrier?

  3. #3
    Join Date
    Apr 2007
    Louisville, KY


    No exam = not a consult (3 or 3 required).

    The great thing about Psych is that if they don't meet 3 of 3, there's usually another code to describe the service . . .

    Surgeon's . . . I just try to find something in CPT. There are special service codes out of Medicine that can apply--depending upon the exact circumstance involved.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  4. #4
    Join Date
    Apr 2007
    Greensboro, NC


    Could you not use time as the contributing factor, as long as the amount of face to face time was documented, and was the greater part of the visit?

  5. #5
    Join Date
    Apr 2007


    I work for a doctor who does consults and are always without the physical exam. I use time for his consults. The time must be documented in the record and state something like over 50% of the time spent was counseling patient.

  6. #6


    Thank you all for your help. I am going to see if there is a code in the medicine section that may apply. I am leary on billing as a consult considering the patient was never seen by the physician. If I can't find a CPT code in the medicine section I will use the unlisted CPT code 99499.

    Thanks again!

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