General Surgery Coding Alert

Question: If I perform an office consultation on a patient, how much time must elapse before I can bill 99241-99245 again for the same patient?

Florida Subscriber

Answer: CPTand Medicare don't restrict how often you can report an office consultation for the same patient. You should bill 99241-99245 (Office consultation for a new or established patient, which requires these three key components ...) if the visit meets a consultation's three criteria:

An appropriate source must request your physician's opinion regarding the patient's condition. The surgeon must render the examination and then report his findings to the requester in writing.

For example, a family practitioner requests your surgeon's opinion on an elderly patient complaining of abdominal pain. Your surgeon evaluates the patient and issues a report to the family physician. You code the visit with 99244.

Six months later, the family practitioner sends the same patient to you for a different condition, such as possible hernia. You may report a consultation for this visit as well, even though the consultations occur within the same six months.

If an insurer denies or downcodes the consultations for frequency, contact the Department of Insurance and report the payer's activities. Your state (Florida) fines payers that downcode 99241-99245 to 99212-99215 (Office or other outpatient visit ...).