When Is It Appropriate to Use Consultation Codes?

Published: 2011-08-08 12:15:10
Author: Samuel A. Collins | Dynamic Chiropractic | August 12, 2011

Q: I have seen the codes for "consultation," 99241-99245. Are these codes I should be using whenever I consult with a patient about their care?

A. These codes are commonly misinterpreted because of the description of the code as consultation. Many will mistake the use of consultation in this coding context to indicate the time during or after an evaluation wherein the patient is given a report of findings, treatment plan and recommendations. This "counseling" is actually part of the evaluation and management service codes (99201-99205 and 99211-99215) and is integral to their use. It is not separately billable under the consultation codes 99241-99245.


Under the CPT coding system, a consultation is a type of evaluation and management service provided by a physician at the request of another physician or other appropriate source to either recommend care for a specific condition or problem, or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem. It is not used as a code for evaluation and management, nor the counseling associated with it. In simple terms, consultation codes are used to represent second-opinion visits.

If counseling is the component you are looking to code for, it is included in the evaluation and management service. And if counseling is needed outside the initial or follow-up exam, an appropriate established patient E&M service could be used based on the extent of the counseling session.

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