Is This A Consultation?

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Question:

I saw a first-time patient in my office who was referred to me by her aunt. Can I bill a consultation code?

Answer:

Good question. While it might seem like a consultation because that’s the service you provided, it is not a consultation from a CPT coding standpoint. First, remember that Medicare (and many other payors) have not reimbursed for consultation codes (9924x, 9925x) since 2010 so you’ll need to use a new patient (9920x) or established patient (9921x) code instead.

But in the scenario you describe, CPT considers this to be a new patient code (9920x). CPT says: “A “consultation” initiated by a patient and/or family, and not requested by a physician or other appropriate source (e.g., physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company), is not reported using the consultation codes”.