Wiki Consultations

[REGINALD068]

Happy Holidays Fellow Coders!!!

Can someone guide me to where I can find documentation, in one of the coding publications, regarding the guidelines to writing a consultation? I've done some research about it, and found there are four R's (Request, Reason, Report, Return).

Thanks

 

[Pathos]

Yeah, there are some guidelines out there. You are correct about the 4 Rs, but here are some references to start with:



AAPC Consult or Not by G.J. Verhovshek, MA, CPC

AAPC Consultation Coding for Medicare by G.J. Verhovshek, MA, CPC

United Healthcare Consultation reimbursement policy

 

[REGINALD068]

Also, can someone guide me on what elements constitute/support a consultation? As with regular E/M visits, are the rules the same(CC/HPI's, ROS.PFSH, Body Areas/Organ system review).

 

[Pathos]

In terms of E/M element requirements, New Patient and Consultations are identical.

 

[REGINALD068]

So
99241= 99201
99242 = 99202
99243 = 99203
99244 = 99204

 

[Pathos]

Correct, when it comes to E/M components (History, Examination and Medical Decision Making).

Note that some insurances do not accept Consultations, make sure to check your payer.

CMS E/M guidelines