Pediatric Coding Alert

Question: Can I perform a consult on my own patient?


Florida Subscriber

Answer: Yes and no. CPT Codes does not restrict consultations to new patients. Consultation codes make no differentiation between a new and established patient, only between an outpatient (99241-99245, Office consultation for a new or established patient) and inpatient (99251-99255, Initial inpatient consultation for a new or established patient …).

You may report a consultation code if you:

• receive a verbal or written request for a consult from an appropriate source
• render a service including your opinion and/or advice
• report your findings in writing to the requestee.

A perfect time to use office consultation codes on established patients is for preoperative exams. For instance, if a dentist requests preoperative clearance on your patient who has a heart murmur prior to tooth extraction, you may code the preoperative exam as a consultation (99241-99245). Payers usually prefer that you report the diagnoses in this order:

1. the chronic condition (785.2, Symptoms involving cardiovascular system; undiagnosed cardiac murmurs)
2. the reason for surgery (521.0x, Dental caries)
3. the preoperative exam (V72.83, Other specified pre-operative examination).

Exception: Although not consistent with CPT guidelines, state laws and private-payer policies may disallow reporting consultation codes for established patients. Georgia Medicaid prohibits coding a consultation on your own patient. Make sure you know your contracts before coding 99241-99245.