E/M Coding Alert - 2015 Issue 10
Reader Question: Outline Consultation Requirements
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Article Overview
This reader question addresses how consultation services are billed when one physician asks a surgeon for an opinion on a patient. It outlines the general nature of consultation reporting, the documentation elements typically associated with the service, and the need to account for payer rules when consultation codes are not accepted. The article is aimed at physician practices, surgeons, and coding staff who need a high-level understanding of consultation claim handling without relying on the premium content.
Why This Topic Matters
Consultation billing is a common source of claim denial and documentation questions, especially when payer policies differ. Understanding the broad requirements helps practices determine whether a visit fits consultation reporting and when alternative office/outpatient visit coding may be needed.
What You Will Learn
- The general circumstances under which a physician service may be treated as a consultation.
- The broad documentation elements associated with consultation reporting.
- How payer policy can affect whether consultation codes are accepted.
- What to consider when a consultation does not result in transfer of care.
Who Should Read This
- Physicians
- Surgeons
- Medical coders
- Billing staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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