Crystal's MCW Coder HubTags: cpt consultation inpatient
Overview
Consultation codes are used when a physician is asked to evaluate and provide opinion/treatment recommendations.
Inpatient Consultation Codes
Medicare Does Not Pay
Medicare does not recognize consultation codes (99251-99255). Bill initial/subsequent hospital care instead.
Consultation Requirements (Non-Medicare)
The 3 R’s
- Request: Written or verbal request from another provider
- Render: Provide opinion/recommendations
- Report: Send written report back to requesting provider
Documentation Elements
| Element | Requirement |
|---|---|
| Request | Document who requested and why |
| Opinion | Clear assessment and recommendations |
| Report | Documentation of communication |
When to Use Consult vs. E/M
| Scenario | Code Type |
|---|---|
| Transfer of Care | Initial Hospital Care |
| Opinion Only | Consultation |
| Co-Management | Subsequent Hospital Care |
| Medicare Patient | Initial/Subsequent Hospital Care |
Payer Specific
Always verify payer policy. Many commercial payers follow Medicare rules and don’t pay consultations.