tci General Surgery Coding Alert - 2021 Issue Q1

Reader Questions: Dissect Office or Consult E/M Choice

Question: Our surgeon examined a patient in the office and sent a report about the patient’s condition to a provider who requested it. Should we bill an office evaluation and management (E/M) or a consult (99451 or 99452) or both? Louisiana Subscriber Answer: If your surgeon provides information about the patient to another provider who requested a consult from your provider, you should report only a consult E/M code (unless the payer is Medicare), not an office E/M code. If the surgeon documents a consult, you should not bill 99452 (Interprofessional telephone/Internet/electronic health record referral service(s) provided by...

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