tci Medicare Compliance & Reimbursement - 2016 Issue 22

E/M Coding: 3 Tips Lead to Seamless Consultation Coding

Consult coding is still going strong for some private payers—if you know how to report it. When Medicare stopped accepting claims for consultations several years ago, many pediatric practices thought that was the end of their consult coding days. However, CPT® did not do away with the consult codes, and consequently many private payers still reimburse for the service. In fact, earlier this year, United Healthcare solidified its stance on consult coding, noting “UnitedHealthcare will consider a claim for a consultation service for reimbursement if the requesting physician or other qualified source is identified on the claim...

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