Use subsequent care codes instead of follow-up consults, but correct codes for confirmatory consults depends on payer

Why This Topic Matters

Accurate handling of consult-related E/M services affects compliant billing across multiple settings and payers. The article helps readers understand where CPT guidance and Medicare policy align or differ so they can identify the correct code family for the service setting.

Article Sections

1. Overview of deleted consult code series

   Introduces the article’s focus on consultation-related evaluation and management services after certain code series were removed. It frames the discussion around subsequent care, confirmatory services, and payer differences.

2. CPT guidance for follow-up and confirmatory consults

   Summarizes the CPT direction discussed in the article for post-deletion consult reporting. It also references payer-mandated consultation scenarios and the related modifier context.

3. Medicare guidance and transmittal update

   Describes Medicare’s differing approach, including updated manual guidance and examples. It covers how the policy addresses consult requirements, service settings, and alternative E/M categories.

4. Setting-specific coding considerations

   Outlines the article’s comparison of inpatient, nursing facility, office, and other outpatient settings. It emphasizes that reporting options vary depending on whether consult requirements are met.

5. Medicare’s view of mandated services

   Highlights the article’s discussion of payer-mandated consultation claims and Medicare’s position on related service reporting. It also touches on the broader treatment of second-opinion requests under Medicare policy.