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.