Medicare Compliance & Reimbursement

Question: I am still a little confused about the consultation codes 99241--99245 and 99251--99255. Are these codes deleted completely or are they still being used for private insurance? What codes should my doctor use for coding consultations?

Answer: CPT did not delete consultation codes 99241--99245 (Office consultation for a new or established patient ...) and 99251-- 99255 (Inpatient consultation for a new or established patient ...) for 2010.

The catch: Medicare is not recognizing, accepting, or paying for the consultation codes. Some private payers have followed suit. But some private payers are still paying the consultation codes. You need to check with each individual insurance company to see what their policy is this year.

Instead of reporting consultation codes, you would report new or established patient office visit (99201--99205, 99211--99215, Office or other outpatient visit for the evaluation and management ...), initial (99221--99223, Initial hospital care ...) or subsequent hospital care (99231--99233, Subsequent hospital care), or initial or subsequent nursing facility care (99304--99306, Initial nursing facility care, per day, for the evaluation and management of a patient ...) codes for these services.