Are You Still Using Confirmatory Consult 99271?

If you’re seeing denials of your medical billing claims for confirmatory consultation and you aren’t sure why it is occurring, the Current Procedural Terminology codes were eliminated in January 2006. This change affected the way many treatments were approached and the amounts that practices will be reimbursed.

A confirmatory consult in medical billing is defined as a visit where one physician confirms the opinion of another physician. The current procedural terminology codes used are 99271-99275 (Confirmatory consultation for a new or established patient) for a confirmatory consult. This code range is now defunct.

There are now two options in medical billing for coding a confirmatory consult. You should either report a consultation or a non-consultation code. The confirmatory status will no longer have anything to do with the medical billing process. This change could negatively affect your bottom line if you keep reporting the old CPT code on your medical billing.

With the updated guidelines, most confirmatory consults will no longer qualify to be coded as a consultation. Most of these services can only be coded as an evaluation and management exam.

The other way your practice may lose money is if an established patient consultation is charged. If you see an established patient who would have been considered a confirmatory consult in 2005, you would have to merely code as an established patient consult. If you used medical billing code 99213 instead of 99273, for example, you will lose approximately $38.27.

Make sure that your staff knows the correct codes to use to insure you get the maximum reimbursements or consider it might be time to outsource your medical billing to a third party partner who can take the time and help you get the maximum reimbursements possible on each and every medical billing claim.

View all Articles by: Melissa Clark, CCS-P