Wiki consult question 99244 and 99243

[dalanicks@aol.com]

I need advice, There are many doctors in my office with different specialties, = we bill under the same tax id as the group, I have three doctors that refer to this one doctor for consultation who does EMGS and NERVE CONDUCTION tests. He takes a lot of time with these patients and his notes are beautiful. However, should they be using 99243 consult code or a new patient. I was thinking new patient, I would like to know if this is correct, Thanks!

 

[jluvl88]

Consultation vs New Patient

First determine which insurance company you are dealing with. Medicare will not pay for consultations, so bill all of those as NP. For commercial/other payers, I would recommend checking your fee schedules to see which code reimburses at a higher rate. For our practice, consultation codes almost always pay more than typical office visits, new or established. 9924X consult codes can be used for new or established patients, so check your reimbursements.

 

[dalanicks@aol.com]

consult question 99244 and 99243

OK THANK YOU, but I guess what I really want to know is can they consult in the same practice? completely different doctor like I had said, he does tests and procedures to see if they need surgery.

 

[espressoguy]

OK THANK YOU, but I guess what I really want to know is can they consult in the same practice? completely different doctor like I had said, he does tests and procedures to see if they need surgery.

You can absolutely bill consult or new patient if the consulting provider is a different specialty or a recognized subspecialty.

 

[Rhonda Hammond]

3 years later??

First determine which insurance company you are dealing with. Medicare will not pay for consultations, so bill all of those as NP. For commercial/other payers, I would recommend checking your fee schedules to see which code reimburses at a higher rate. For our practice, consultation codes almost always pay more than typical office visits, new or established. 9924X consult codes can be used for new or established patients, so check your reimbursements.

Do you think you would have the same response to this questions? I am have the same scenario and I am billing EMG consults- New patients and these are all PIP patients and I wanted to know the same thing. Please advise.

 

[Orthocoderpgu]

Don't forget the definition of a consult

A "consultation" is when Dr. A needs advice from Dr. B and Dr. B reviews the medical records, possibly examines the patient and reports back to Dr. A.

Just sending a patient from one physician to a different physician is not a consultation. CMS reviewed medical records for consults and three years in a row 95% of the time the documentation did not support an actual consultation, which is why CMS stopped paying for them.

In order to bill a NP, the Dr. B will need to be credentialed differently than Dr. A. Otherwise, they are two docs working in the same office.

I have two hand surgeons. One I can bill a NP on because of the way he was credentialed, and one I can't because he was just credentialed as an ortho surgeon, not a hand specialist. You need to look at that too.