Another Physician has asked My Advice and Opinion on a Patient's Care. How do I Bill this to Medicare?

Medicare no longer recognizes the Current Procedure Terminology (CPT) consultation procedure codes (99241- 99255). The documentation requirements applicable to those codes no longer apply. Therefore, the medical record documentation must support the evaluation and management (E/M) code billed to Medicare. The medical record must also support medical necessity for the service.

The Comprehensive Cert Error Testing (CERT) contractor assesses an error when the service provided is documented per the previous consultation requirements and submitted with an E/M procedure code, but the medical record does not support the level of service billed. On the Medicare claim, the provider should bill an E/M code that is appropriate for the place and level of service performed and documented in the medical record. The consultation procedure codes contained many more levels of service than the initial procedure codes. In some cases, the medical record documentation will not support the lowest level of an initial visit. The Centers for Medicare & Medicaid Services (CMS) Publication SE1010 indicates contractors will not find fault with a provider billing a subsequent visit when an initial has not been performed.

More information on this subject is available on our Evaluation and Management (E/M) web page. You may access this page by selecting the Resources tab in the top navigation, then Provider Specialties/Services. Look for the Evaluation and Management (E/M) link under the heading Provider Services.

Page Last Updated: Friday, 11-Nov-2011 12:06:21 CST