READER QUESTION:
Stop Counting Your Cardiologist's Consults
Published on Thu Nov 16, 2006
Question: How often can we report consult codes for the same patient? We saw a patient in July for a consult, and then the cardiologist saw her again for another consultation in October. Can we bill both consults?
Florida Subscriber
Answer: The outpatient consultation codes (99241-99245) do not have outlined restrictions regarding how frequently you can use them, and the patient does not need to present with a new problem for you to use an additional consultation code.
According to CPT 2006, "If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again."
Typically, when a patient returns for an additional consultation, he has a problem that is unrelated to the original complaint or has a progression of the original problem. If the physician performs an additional consultation for a given patient, be sure the documentation includes a detailed explanation for the subsequent consultation(s).
Rule: Medicare policy (Medicare Claims Processing Manual, Chapter 12) states that "if the consultant continues to care for the patient for the original condition following his/her initial consultation, repeat consultation services shall not be reported."
