Most of us follows the guidelines of the 3-years face-to-face new
patient consult code versus established patient code.
A consult Code 99241-99245 can actually be billed even though the
patient was last seen 12 months ago. Ofcourse!
Let's look at this very good example:
> A primary care physician requests a second opinion for his patient
who has chronic back pain from a Pain Management Specialist.
The specialist will then see the patient, send a copy of his medical
evaluation report including his treatment plan, prognosis, etc to the
Primary Care Physician. NOW- the physician just rendered a CONSULT
CODED service.
> After 12 months, the patient let's say was involved in a car
accident and developed a herniated disc injury. The primary care
physician then sends back the same patient to the specialist for a
second opinion request. This is just less than 3 years.
The specialist can then code for a new consult since he evaluated
the patient for a new problem completely different from the previous
problem 12 months ago!
Now, compare how much you are losing if you do not know this.
Compare your reimbursement or contracted rate using a Consult Code
against an Established Patient Code!
You will be surprised!
**** For more references: Consult your CPT code books. The
National Correct Coding Initiative (NCCI) and third pary payer
payment policies and guidelines
*** another helpful article from Ms. Pinky
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