When to use consultation code?

What qualifies as a consultation?

A consultation request typically comes from a physician who is seeking the opinion and advice (report) of another physician, usually a specialist, on how best to treat a patient with a specific problem (reason).

What are the 3 questions a coder must ask themselves when selecting an E&M code?

Many E/M codes, such as those for inpatient care and home visits, include a combination of patient history, examination, and medical decision making (MDM). These factors — history, exam, and MDM (HEM) — are known as the three key components of E/M level selection.

What documentation is required for a consultation?

A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source.

Can nurse practitioners bill consultation codes?

Physicians and qualified non-physician practitioners shall code consultation visits as patient evaluation and management visits utilizing the CPT Evaluation and Management codes that represent where the visit occurs and that identify the complexity of the visit performed. CPT consultation codes shall not be utilized.

What is the difference between a referral and consultation?

For clarity, we refer to Consults as requests that are fulfilled in inpatient or emergency contexts and Referrals as requests that are fulfilled in outpatient contexts. The “Consultant” is the physician fulfilling the request and the “Referrer” is the prescriber generating the request.

When should consultation occur?

Consultation is required when identifying hazards, assessing risks and deciding on measures to eliminate or minimise those risks. In deciding how to eliminate or minimise risks, you must consult with your workers who will be affected by this decision, either directly or through their health and safety representative.

Why do we use consultation?

To tell them what you want them to know (e.g., to forewarn them of an initiative planned by you or by others) To ask their opinion (e.g., by “floating” a proposal) To learn their intentions. To get their agreement to what you want.

What are the three types of consultation?

What is consultation code?

A consultation code may be billed out for an established patient as long as the criteria for a consultation code are met. There must be a notation in the patient's medical record that consultation was requested and a notation in the patient's medical record that a written report was sent to the requesting physician.

When did CMS stop accepting consult codes?

The Centers for Medicare & Medicaid Services (CMS) has eliminated the coverage of consultation codes as of January 1, 2010.

When should a consultation be carried out?

If your employer is proposing to make 20 or more redundancies, they must hold collective consultation. If your employer is proposing to make fewer than 20 redundancies, they should consult with you individually.

When can you bill a consult?

Criteria for consultation

The service is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source (unless it's a patient-generated confirmatory consultation, e.g., a second opinion).

What are the three R's for coding consultations?

The “Three R's of Consultations” include documentation of the request, rendering of the service and report back. The report should be some formal communication to the requesting professional.

Can nurse practitioners run a code?

Q: Do you run codes and/or intubate patients? A: No. In the emergency department where I am employed, nurse practitioners do not run codes or intubate patients. This is not true of nurse practitioners in all ER settings, particularly those working in rural settings or in critical access hospitals.

What are the 5 C's of consultation?

Recently, the 5Cs of Consultation model (Contact, Communicate, Core Question, Collaborate, and Close the Loop) has been studied in Emergency Medicine residents using simulated consultation scenarios.

What counts as a consultation?

Consultation is the act of seeking assistance from another physician(s) or health care professional(s) for diagnostic studies, therapeutic interventions, or other services that may benefit the patient.

What requirements are needed for coding a consultation?

What is the golden rule of medical coding?

The golden rule of healthcare billing and coding departments is, “Do not code it or bill for it if it's not documented in the medical record.” Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises.

What is the CPT code for consultation?

What is the difference between 99213 and 99214?

The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.