I did find the resident using the verbage "counseling" in doucmentation. Since Medicare doesn not accept consultations we have a cross walk of codes to referr to . Eg. 99241 should be billed as 99204. That is what I think happened. How do I handle that I am not sure, I put Modifier 27 on to the 99214 (that is the second visit of the day and the 1st visit is documented recheck, so this is an established patient.