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Thread: consult coding

  1. #1
    Join Date
    Apr 2007
    Anaheim, CA

    Default consult coding

    AAPC: Back to School
    1. If we are coding an ortho E/M consultation, and according to the Dr's dictation / documentation we reach to a decision that

    HPI 99243/99242

    Exam is 99243 and

    MDM is 99244 i.e.moderate complexity

    which code should finally be coded for the visit. we need 3/3 key components for consult visits.

    2. For a fracture consultation visit to a specialist, is the Dr. supposed to be doing a detailed ROS, comprehensive exam of all other organ systems. I think any doctor will just pay attention to the fractured part of the body. Does that mean they can never code 99244 where as the closed Tx of the Fx or dislocation without manipulation is considered as moderate complexity.

    I would like to thank you for your time in advance, really appreciate any comments on the situation.



  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    1. Since you need 3 of 3 for a consult, you have to go with the lowest key component.

    2. If the doctor is assuming care of the fracture, technically it is no longer a consultation and should be coded as a new patient. Use the 1997 exam guidelines and you won't need to worry about all other organ systems for the exam. Some carriers will accept an E/m with mod -57 and the frracture care code, some will only accept the fracture care code. If the patient was sent for definitive treatment of the fracture from another provider, I would lean towards only the fracture care.

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