Orthopedic Coding Alert

Question: Is it true that we can never code for E/M “consultations?”

Codify Subscriber

Answer: No, it is not true that you can never code for E/M consultations.

Although Medicare stopped accepting consultation codes many years ago, other payers may still continue to recognize the CPT^® codes for these services: 99241-99245 (Office consultation for a new or established patient, which requires these 3 key components: …)

To use these codes, you must document three key components:

• Request for your surgeon’s opinion, which includes the reason for the consultation
• Rendering the service in order to develop an opinion (the consult visit)
• Reporting back to the requesting clinician with the opinion.

Coding Tip 1: Never use the word “referring physician” in a consultation case. That language indicates that a different provider is sending the patient to your surgeon to take care of the patient. A consultation does not involve a transfer of care.

Coding Tip 2: If your claim does not identify the requesting provider, the payer will almost certainly deny the consultation service because it does not meet basic CPT^® requirements for reporting such a code.