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Ophthalmology and Optometry Coding Alert

Reader Question:

99241-99255: Keep Consults When Possible

Published on Thu Apr 05, 2012

Question: Can we still use "consult" E/M codes?North Carolina SubscriberAnswer:  The answer to that question depends on the payer. If your insurer accepts the codes, then yes, you can continue to use E/M consultation codes.Starting in 2010, Medicare discontinued recognition of the consultation codes 99241-99245 (Office or other outpatient consultation ...) and 99251-99255 (Initial inpatient consultation services ...). Some payers continue to accept these codes, however, and CPT® maintained the codes in 2011 and again in 2012.Opportunity: You shouldn't stop using the consultation codes if your payer accepts them. The codes pay 40 percent more than other E/M codes that have comparable levels of history, physical exam, and medical decision-making. The key is to be sure the use of consultation codes meet the definition of what a consultation is all about. Just using them when a patient is new and referred to your practice does not meet the definition. In [...]
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