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Wed Nov 01, 2017 11:23 am

If a service has signed off of a patient and is then re-consulted for change of condition during the same stay, is this billed as a consultation/initial visit or a subsequent visit? Date last seen 7/3/2017; Re-consulted 9/18/2017
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Shoshana, BA, CPC, CPMA, CPCO, RRT
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Wed Nov 22, 2017 10:25 am

This is not a black and white consideration. If the provider was truly consulted, asked for their opinion, not managment, then a consultation code would be supported IF the insurance allows them. The documentation needs to support who requested the consult, why the consultation is needed, and an indication that the information was routed back to the requesting provider.

If the insurance does not accept consult codes, it depends on the setting. In the outpatient setting, an established patient code would be used (99212-99215), in the inpatient setting (same admission), a subsequent care encounter would be used.

Your question has been answered by Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC
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