The Difference Between
"Consultation" and "Counseling"

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

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 appropriate.

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 second day.

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.

Return to the CHIROPRACTIC ASSISTANT Section