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OFFICE CONSULTS
 

 

Office Consults (99241-99245)

As of January 1, 2010, MEDICARE no longer pays outpatient (or inpatient) consults.

To view a 7-minute video on how hospital consults should now be coded, click HERE

To download our CONSULT ALGORITHM and fact sheet in PDF format, click HERE

These codes are used to bill for office consultations with new or established patients.  These codes are also used to bill for consults performed on patients in the ER or admitted under "observation" status.  Internists performed a total of 1,012,718 of these services in 2003.  A consult is provided by a physician whose opinion or advice is requested by another physician about a specific clinical problem or issue.  Consultations may also be requested by nurse practitioners or physician assistants.  The name of the requesting clinician and the reason for the consultation must be recorded in the chart.  The results and recommendations of the consult must be sent to the requesting physician.  Do not use these codes for consults initiated by a patient or a family member.  (Those services are reported using the separate codes for confirmatory consultations.)  If the consulting physician assumes partial care of the patient after the initial consultation, those additional services are reported as established office visits -- NOT as consultation services.   There are five levels of care for this type of encounter which all require the documentation of three out of three key components

Level E/M Code History Physical Exam MDM Time
1 99241 Problem Focused Problem Focused Straightforward 15
2 99242 EPF EPF Straightforward 30
3 99243 Detailed Detailed Low 40
4 99244 Comprehensive Comprehensive Moderate 60
5 99245 Comprehensive Comprehensive High 80
For these encounters, documentation of three out of three key components is required for any given level of care
This topic is covered in more detail in of one of our web-based E/M coding courses.
 

E/M Consult Services

Consult Services   Related Topics
 

 

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Although Medicare no longer pays for consult services, some private payers still do. But beware. Auditors love to downcode these visits when doctors don't include the exact right terminology. Learn to get it right.  
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