tci General Surgery Coding Alert - 2004 Issue 4

You Be The Coder: Can 'New' and 'Established' Affect Consults?

Question: May I bill a consult for an established patient (last seen two years ago) seen by a new surgeon in our office? This is a new episode of the same problem the patient had earlier.New Mexico SubscriberAnswer: Although standard outpatient visits distinguish between new (99201-99205) and established (99211-99215) patients, office consults (99241-99245) require no such distinction. Rather, consults apply to new or established patients.When determining if you may report a consult, you must demonstrate that you have met the minimum requirements of a request (from the physician sending the patient for the consult), a opinion rendered...

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