decisionhealth Newsletters, Part B News - 2018 Issue 3 (March)
Some payers accept consult codes — but be sure that’s what you did
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Article Overview
This premium article discusses consultation evaluation and management coding in the outpatient and inpatient settings, with emphasis on payer acceptance after Medicare stopped paying certain consultation services. It is relevant to practices that bill commercial insurers, and it addresses the general purpose of consultation services, how payer policies can vary, and why providers should confirm coverage before submitting claims.
Why This Topic Matters
Consultation coding can affect claim acceptance, payment, and compliance, especially when payer policies differ from Medicare and may change over time. The article helps readers understand the broader coding context so they can determine whether a service should be billed as a consultation or under another E/M category.
What You Will Learn
- How consultation E/M coding is treated by different payers
- Why Medicare’s policy affects but does not fully determine commercial billing practices
- The general purpose of a consultation service versus other patient-care encounters
- Why payer policy verification matters before submitting claims
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
Codes Discussed
Code Ranges Discussed
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