E/M Coding Alert - 2017 Issue 2
Reader Question: Document '3-Rs' for Consultation E/M
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Article Overview
This reader Q&A addresses consultation evaluation and management coding in a payer environment where Medicare no longer recognizes consultation codes but some other payers may still do so. It is aimed at coders, billers, and clinical documentation staff who need a high-level understanding of consultation documentation themes, payer recognition, and common claim-denial pitfalls without relying on the premium article.
Why This Topic Matters
Consultation E/M claims can be denied if documentation does not support the service type or identify the requesting provider. Understanding the general documentation themes and payer differences helps practices reduce avoidable denials and improve claim accuracy.
What You Will Learn
- How consultation E/M services are treated differently across payers
- What broad documentation themes are associated with consultation reporting
- Why requesting-provider identification matters for claim submission
- How consultation documentation differs conceptually from a transfer of care
Who Should Read This
- Medical coders
- Billing staff
- Compliance staff
- Physicians and clinical documentation staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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