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Consulting Charges vs. New Patient Visits

Consulting Charges vs. New Patient Visits

I thought I would post these thoughts today; as these billing issues have continued to pop-up frequently. As coders, we know that there are many instances when a Consultation charge would be applicable to bill for a physicians’ service. These codes include 99241-99255 However, time and time again I see this mistake occuring when billing for my own client’s who code their superbills. The OIG has issued many intensified directives when billing illegal Consultation charges.

I believe that the best example would be as follows to describe the difference and when to use and when not to use a consultation charge.

If Dr. Happy refers a patient to obtain an opinion from specialist Dr. Excited, and Dr. Excited renders said opinion and then sends the patient back to Dr. Happy then a consultation charge is acceptable.

If however, Dr. Happy refers a patient to obtain an opinion from specialist Dr. Excited, and Dr. Excited renders opinion and does virtually anything else; i.e. wants to see the patient in follow-up, provides the patient with any kind of procedure, then a New Patient E and M should be billed, according to the place of service where it occured.

Some believe that to bill a consultation then a turnover of ALL care is needed; however from everything that I have read and articles from CMS and OIG; this is not the case.

I think the key to remember is this, if an MD offers their opinion and sends the patient back to original requesting physician then it is a consultation. Make sure the opinion being sought is well documented, so that there can be no question in billing for a consultation charge.

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