Quick Answer: How Do I Bill For Consultation?

What are the three types of consultation?

There are three consultation models: Collaborative-dependent.



What is consultation codes in medical billing?

A consultation code may be billed out for an established patient as long as the criteria for a consultation code are met. There must be a notation in the patient’s medical record that consultation was requested and a notation in the patient’s medical record that a written report was sent to the requesting physician.

Can providers bill for phone calls?

For example, most health plans don’t pay for telephone calls, and they do not allow physicians to charge patients for such calls, because the plans consider payment for these calls to be bundled. … If the service is unrelated to a service that has been billed to Medicare, the physician may bill the patient.

Can you bill e/m without patient present?

If the patient’s children or spouse present to the practice to discuss the patient’s condition with the doctor and the patient is not present, you cannot bill Medicare using the E/M codes. Although CPT® rules support reporting the E/M codes without the patient present, CMS sings a different tune.

How do I bill for phone consultation?

CPT Phone Codes99441 phone call 5 to 10 minutes of medical discussion.99442 phone call 11 to 20 minutes of medical discussion.99443 phone call 21 to 30 minutes of medical discussion.

When can we use consultation codes?

The guidelines for use of the consultation codes simply indicate that use of these codes requires that one physician is responding to a specific request for opinion/advice from another physician regarding evaluation and/or management of a specific problem.”

What are the 3 R’s of a consultation?

The “Three R’s of Consultations” include documentation of the request, rendering of the service and report back. The report should be some formal communication to the requesting professional.

How do you bill a second opinion consultation?

If the second opinion is requested by the patient and/or family, report the E&M codes (99201-99205) for a new patient and established patient (99212-99215). A new patient is anyone who has not had a face-to-face encounter with any provider in the practice for more than three years.

What is a telephone consultation?

While telephone consultations are regularly used to triage calls, patients can also be diagnosed by doctors this way. … Difficulties can arise when doctors try to reach a diagnosis via the telephone when the complexity of the patient or the condition means a face-to-face consultation is required.

How do you code a consultation?

Consultations mandated by third-party payers (e.g., a mandatory second opinion) should be reported with modifier -32 appended to the code for the consultation service. Consultations can be requested of another physician in your group who has expertise in a specific medical area.

What is considered a consultation?

CPT® defines a consultation as “a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.” To substantiate a consultation service, documentation must include three elements: a request, a …

What is the consultation model?

This model looks at the process of the consultation from initiating the session, gathering information, providing structure to the consultation, building a relationship, giving information by explanation and planning, and closing the session.