# Need Help W CONSULT code(s)



## aikido22 (Aug 28, 2012)

If you do not have the formal consult request (99251-99255), do you down code to 99221 -99223, etc or do you downcode to the subsequent visit 99231 -99233 etc?

Also, this is for non medicare insurance** 
I know for Medicare patient's we only use code 99221-99223.


----------



## FTessaBartels (Aug 29, 2012)

*Yes*

Well, the answer to your question depends on several factors.  

If the patient is covered by Medicare (or a carrier who is following CMS guidelines re consults), then you code based on whether this is the FIRST inpatient visit or a subsequent inpatient visit.  

If the patient is covered by a carrier who accepts the consultation codes, then you have to code as subsequent (because those carriers only accept ONE initial hospital visit code, from the admitting physician).

Hope that helps.

F Tessa Bartels, CPC, CEMC


----------

