Wiki Consult or E&M

[tdybear829@aol.com]

We have a patient's daughter who is coming in to consult with the provider prior to an appointment being made for the patient. I know we can bill this appointment, but it is being debated within the office as to if we should billl an E&M code or a Consult code for this visit. All help & thoughts greatly appreciated!!

 

[Lynda Wetter]

A consult code would require a request from another physician. Maybe look at page 45 in CPT for other possiblilties???
Would love to see input from others too...

 

[BarCode]

This would be a visit code. A consult should be referred by a healthcare provider.

 

[mitchellde]

it sounds like a case for 99358 since you are wanting to bill the patient's insurance. this code is for non-face to face, that means non face to face with the patient.

 

[brookievb]

Maybe not billable?

E/M

Per CPT guidelines states that face-to-face time is defined as only that time spent face-to-face with the patient and/or family. Because of this definition, I do not think you could bill two different E/M's but rather combine the visits and bill one E/M according to documentation or total time and prolonged E/M timing codes if doc supports.

I agree that this is not a consult. From a payor point of view, I would've denied this if this came in as a consult for the reasons others suggested--consults should be from a healthcare professional.

Thanks! Good question! Made my brain think and made me do some research!