Part B Coding Coach: Say Hello to Higher Consultation Payments in 2006 With 6 Easy Steps

Why This Topic Matters

Consultation coding changes can affect which E/M services are reported and how claims are supported in the record. Understanding the shift away from certain consult subsections helps practices reduce denials and align reporting with documentation and payer expectations.

Article Sections

1. Report subsequent care codes instead of follow-up consults

   Explains the retirement of a consultation subsection and the move to other evaluation and management categories for continued care after an initial consult. Includes a discussion of hospital and facility settings and why the change affects reimbursement.

2. Double-check documentation for subsequent hospital care

   Reviews the documentation support expected for higher-level subsequent hospital care reporting. Emphasizes the importance of aligning the record with the level of service billed.

3. Only one initial inpatient consult per admission

   Covers the rule structure for initial inpatient consult reporting across an admission and how later encounters are handled. Also notes the effect of discharge and readmission on reporting options.

4. Choose the most appropriate E/M for second opinion visits

   Discusses how second-opinion encounters are handled when there is no documented physician request versus when a request is documented. Addresses the shift away from a deleted consultation subsection to other visit types.

5. Be vigilant with second opinion visits

   Offers general compliance-focused reminders for second-opinion encounters, including intake verification and beneficiary notice considerations. Highlights the importance of medical necessity and payer review.

6. Continue using the 3 R's for consults

   Summarizes the core consultation documentation framework that still applies when a consultation code is reported. Also notes the distinction between a consultation and a transfer of care.