Consultation (Note: in 2010 Medicare no longer
recognizes Consultation Codes)
A consultation has four elements that
distinguish it from other services:
- Consultations involve rendering an
opinion or giving advice only.
- Consultations must be requested by the
patient's attending physician or other appropriate source and the
need documented in the medical record.
- Consultations do not involve active
management of patient problems although the consultant may initiate
diagnostic and/or therapeutic services. If responsibility for
ongoing care is assumed, subsequent services are no longer
- Consultations include a formal report
containing the opinion or advice that was sought.
Consultation: Services rendered by
a physician whose opinions and/or advice is sought for the evaluation
and/or management of a specific problem. If the visit is for a
consultation, the code should be selected from the following ranges:
Codes 99271 - 99275 are assigned when the
consulting physician has been requested to confirm the medical treatment
and/or a surgical procedure, as in the case of providing a second or
third opinion. Unlike other consultations, confirmatory consultations
provide only an opinion and/or advice. Modifier -32 should be reported
with all confirmatory consultations.
- Suspected problem.
- Undetermined course of treatment.
- Attending physician to decide who will
manage patient care...this is undetermined at time of the consult.
- Consulting physician must submit a
written report to the requesting physician listing findings and
Transfer of total or specific care of a
patient from one physician to another. If the visit is an initial
evaluation for a patient that has been referred, the CPT code would be
selected from the following ranges:
- Known problem.
- Prescribed and known course of
- When patient is referred to
specialist, it is with the intent of transferring management of
total care or a portion of patient care to the other provider
- No written letter or report is