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Otolaryngology Coding Alert

Reader Question:

Count Self-Referrals as Office Visits

Published on Tue Oct 14, 2003

Question: A patient who has frequent sinus headaches self-referred herself to my otolaryngologist. Since she requests the physician's advice on her condition and treatment, may I report a consultation (99241-99245, Office consultation for a new or established patient ...)?

Michigan Subscriber Answer: No, you should instead report the visit with the appropriate office visit code. Use 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) for a new patient and 99212-99215 for an established patient (... established patient ...). CPT and Medicare don't consider a patient a valid source to request an opinion.
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