decisionhealth Newsletters, Answer Books - 2010 Issue 9 (September)
Archived - CMS Consults Prior to 2010 / Examples of consults, straight from the CMS regs
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Article Overview
This archived article reviews CMS examples from the Medicare Claims Processing Manual that illustrate when a consultation is considered to have occurred and when it is not. It is intended for coding professionals, billers, and clinicians who need to understand the general documentation and referral context discussed in the CMS examples. The article focuses on consultation scenarios, follow-up patterns, and the distinction between consultation services and other evaluation and management encounters.
Why This Topic Matters
Consultation reporting has long been a source of coding confusion, especially in examples involving referrals, follow-up care, and documentation expectations. This article helps readers compare CMS example scenarios so they can better recognize the type of encounter being discussed and locate the relevant guidance in the Medicare manual.
Article Sections
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Examples That Meet the Criteria for Consultation Services
CMS example scenarios illustrating consultation-service situations and the surrounding documentation context. The section also discusses related follow-up care patterns and reporting considerations.
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Examples That Do Not Meet the Criteria for Consultation Services
CMS example scenarios that fall outside consultation-service criteria and instead point to other types of reporting. The section highlights common documentation and referral situations addressed by the manual.
What You Will Learn
- How CMS frames consultation-service examples in the Medicare Claims Processing Manual
- What types of encounters are discussed as meeting or not meeting consultation criteria
- How follow-up and subsequent visit patterns are presented in the CMS examples
- Which general documentation elements are associated with consultation scenarios
Who Should Read This
- Medical coders
- Billing professionals
- Revenue cycle staff
- Physician practices
- Compliance teams
- Clinical documentation staff
Modifiers Discussed
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