Wiki Consultations

[LLRodgers]

Hello,

Can anyone clear up Consultation codes for me. If a patient had hip pain and decides to go to an orthopedic is this considered a Consultation. Medical Decision is to do surgery.

I read medicare does not accept Consultation Codes. I want to give the best code for the report.

Thank you,
Linda

 

[Orthocoderpgu]

The word "consultation" has multiple meanings especially as used by physicians. However, the AMA's definition of a consultation which the codes are based on is when one physician gets the written opinion of another physician. Notice that the physician initiates the consultation because his buddy knows more that he does. One provider is asking another provider for their professional opinion and getting it in writing. CMS audited consultation codes for three years and found that 95% of them did not meet the definition of a consultation, so they stopped paying for them. About half or more of private insurance companies has followed CMS since.