Question:
Can we still use "consult" E/M codes?North Carolina Subscriber
Answer:
The answer to that question depends on the payer. If your insurer accepts the codes, then yes, you can continue to use E/M consult codes.
Starting in 2010, Medicare discontinued recognition of the consult codes 99241-99245 (Office or other outpatient consultation ...) and 99251-99255 (Initial inpatient consultation services ...). Some payers continued to accept these codes, however, and CPT® maintained the codes in 2011 and again in 2012.
Opportunity:
You shouldn't stop using the consult 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.
Do this for Medicare:
For Medicare and insurers that follow the same rules as Medicare for consults, you should choose one of the following codes for an E/M service that would qualify as a consult, depending on outpatient or inpatient status:
- 99201-99205 -- Office or other outpatient visit for the evaluation and management of a new patient ...
- 99211-99215 -- Office or other outpatient visit for the evaluation and management of an established patient ...
- 99221-99223 -- Initial hospital care ...
- 99231-99233 -- Subsequent hospital care.