Author Topic: Please clarify the time interval for use of consultation codes  (Read 3173 times)

Alice Scott

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 have read that this could be the next, new enforceable initiative.  Please clarify the time interval for use of consultation codes

1.  A level 3-4 inpatient code (99253 or 99254) for sub-speciality consult on an new patient for a specific dx code (ie for Asthma).

2.  If that person needs another "consult" ( same diagnosis another exacerbation a few days, weeks, months later)  can you use 99252 or 99253? or higher if the situation documentation warrant?

3.  If not how do you bill that #2 situation?

4.  How would you bill a new consultation to a known patient (maybe Asthmatifrom situation #2  develops NEW dx Pulmonary embolism)  Do you use the consultation E&M again??

 Maria, RN


1.                   99253 is generally 55-60 minutes spent with the patient (as well as other components)

99254 is generally 75-80 minutes spent with the patient (again, as well as other components)

2.                   This is difficult to answer as it varies from plan to plan.  Some insurance plans only allow for 1 consultation code per

Diagnosis per year (or other specified time period)

3.                   In that case you would have to bill a regular inpatient visit (99231-99233)

4.                   Again, this question will vary from plan to plan.  Some carriers only allow one consultation code to be billed in a

Specific time period by a physician, so if the plan has that kind of a limit you would not be able to bill the 2nd

Consult even if it were for a different dx.  If the plan did not have that kind of limit you could bill it out as the

99253 (or other appropriate level) with the new dx.  Other wise it would have to be billed as another appropriate

E&M code

Hope that is helpful!


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