AMA CPT® Assistant - 2015 Issue 12 (December)

Evaluation and Management: Consultations (Bonus Q&A) (December 2015)

December 2015 page 18a Evaluation and Management: Consultations Question: If a patient with a specific condition or problem is referred to a surgeon, is the surgeon able to report a consultation code? Answer: Often the terms consultation and referral are mistakenly interchanged, but these terms are differentiated in the CPT code set. Careful documentation of the services requested and provided will alleviate much of the confusion in reporting consultative services. As defined in the CPT® 2016 codebook (p 19), "… consultation is a type of evaluation and management service provided at the request of another physician or appropriate source...

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CPT® Assistant content is the official source for CPT® coding guidance. It is an instrumental tool when appealing insurance denials and validating coding to auditors. Monthly issues and an extensive archive provide comprehensive guidance on proper CPT® coding for past, present and upcoming code set releases. Archives date back to 1990 for historical use of codes, changes, rationales, coding tips and trends in the industry.

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