Wiki Consults

[KoBee]

For those payers that DO still take office consult codes 99241-45, what if the "consult" visit does not meet the "3 R's" ? what do you default to? trying to located specific guidelines for this, thank you!

 

[csperoni]

Yes, if your "consult" does not meet the coding definition of consult, you bill an E/M 99211-99205 office; 99221-99233 inpatient. That same rule applied even when all carriers recognized consult codes. The overuse/abuse findings by CMS is what lead to the discontinuation.