Naveen Rachagolla
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An office visit is deemed a
consultation only when the following criteria for the use of a consultation code are met:
1. Consultation is being performed at the REQUEST of another practitioner or appropriate
source requesting advice regarding evaluation and/or management of a specific problem
2. The request for the consultation and the reason for the request must be RECORDED in
the patient's medical record.
3. After the consultation is provided, the practitioner must prepare a written REPORT of his
or her findings, which is provided to the referring practitioner.
If all the listed requirements are not met then the appropriate office or other outpatient (99201-99215)
or hospital inpatient (99221-99223) E/M service should be reported instead of a consultation code.
Some of the confusion in coding consultations begins with the terms used to describe the requested
service. The word ‘consultation' and the word ‘referral' are sometimes incorrectly considered one
and the same. When a practitioner refers a patient to another practitioner, it cannot be automatically
considered a consultation. The service can only be considered a consultation if the above criteria are
met in the service provided. A service provided to a patient who was referred to another practitioner
without written or verbal request for a consultation (which is documented in the patient's record)
should be coded using one of the office or other outpatient codes or hospital care codes.
The decision to request a consultation is exclusively up to the requesting practitioner. The medical
necessity for a consultation is dependent on the clinical judgment of the practitioner. Once the
requesting practitioner receives the report from the consulting practitioner, he or she may either
continue to manage the patient's condition or request the consulting practitioner to take over the
management of the patient's condition from that point forward. If the consulting practitioner chooses
to accept management of the patient's condition after the consultation has been completed, the
appropriate code from the office or other outpatient or hospital inpatient should be used for any
further E/M services provided.
Is this statement above is correct or is there anything new on consultation, your thoughts are highly appreciated.
This is in regards to consultation charts in CEMC exam.
consultation only when the following criteria for the use of a consultation code are met:
1. Consultation is being performed at the REQUEST of another practitioner or appropriate
source requesting advice regarding evaluation and/or management of a specific problem
2. The request for the consultation and the reason for the request must be RECORDED in
the patient's medical record.
3. After the consultation is provided, the practitioner must prepare a written REPORT of his
or her findings, which is provided to the referring practitioner.
If all the listed requirements are not met then the appropriate office or other outpatient (99201-99215)
or hospital inpatient (99221-99223) E/M service should be reported instead of a consultation code.
Some of the confusion in coding consultations begins with the terms used to describe the requested
service. The word ‘consultation' and the word ‘referral' are sometimes incorrectly considered one
and the same. When a practitioner refers a patient to another practitioner, it cannot be automatically
considered a consultation. The service can only be considered a consultation if the above criteria are
met in the service provided. A service provided to a patient who was referred to another practitioner
without written or verbal request for a consultation (which is documented in the patient's record)
should be coded using one of the office or other outpatient codes or hospital care codes.
The decision to request a consultation is exclusively up to the requesting practitioner. The medical
necessity for a consultation is dependent on the clinical judgment of the practitioner. Once the
requesting practitioner receives the report from the consulting practitioner, he or she may either
continue to manage the patient's condition or request the consulting practitioner to take over the
management of the patient's condition from that point forward. If the consulting practitioner chooses
to accept management of the patient's condition after the consultation has been completed, the
appropriate code from the office or other outpatient or hospital inpatient should be used for any
further E/M services provided.
Is this statement above is correct or is there anything new on consultation, your thoughts are highly appreciated.
This is in regards to consultation charts in CEMC exam.
Last edited:
