Answer_Book / Evaluation_and_Management_Services / Select the proper code when you cant bill a consult

Why This Topic Matters

Accurate E/M selection is essential when consult reporting is not available for a payer, especially because the billing path may differ by setting, payer type, and the nature of the request. The article helps readers understand the scope of the policy change and the broad categories of codes involved so they can apply the premium guidance correctly.

Article Sections

1. Policy change and affected E/M code families

   Summarizes the Medicare policy change and the broad categories of evaluation and management services affected. It also frames the general shift from consultation coding to office, hospital, and emergency department reporting.

2. Scenario-based billing guidance

   Walks through a series of referral and encounter scenarios involving diagnostic testing, preoperative evaluation, inpatient requests, follow-up care, and emergency department encounters. The section compares Medicare and non-Medicare approaches at a high level without reproducing detailed coding instructions.

3. Medicare notes and modifiers

   Highlights supporting Medicare guidance related to patient status and coding context. It also notes a modifier consideration tied to inpatient admission-related reporting.