By Ces Soyring
The definition of a "consultation" in coding refers to
a "second opinion." These codes are found on page 15
of the AMA's CPT 2000 book.
However, if you are billing for talking to your own
patient, it is referred to as "counseling".
Counseling is billed under the 99211–5 E/M codes. If
50% or more of your time is based on face to face
counseling and/or coordination of care, the level of
E/M is chosen based on the average times listed after
each E/M code. For example: a 15 minute report of
findings would be listed as 99213. Documentation must
support this service.
Also, there are EXCLUSIONS. For example, you can not
bill for a ROF separately if it was done on the same
day as a new patient or established patient exam (99201–5). If
the service is performed on the same day, counseling
is included with the E/M code used for the exam. The
only thing you might be able to do is to add a –21
modifier for more time or a prolonged physician
service code (99354/55) if length of time is
IF, you are billing for a "consult" with a new
patient, it is still billed under the 9920 codes based
on time, however, if the individual becomes a patient
and an exam is done on a subsequent day, the "new
patient" code can not be billed again and an
established patient E/M code must be used on the
As far as the "proper DX" is concerned...I'm not sure
what they are referring to, but my guess is that under
a true consultation the area of complaint would match
the primary doctor's DX. (The DXs might not match,
but the regions or areas evaluated would be the same.)
Does that make sense?
I hope this information is helpful, if you need
further assistance please feel free to email Ces Soyring.