Place of Services: Consults

Question 1

Consults involve

Answer 1

another physician, specialist or other medical provider being brought in to assist the initial provider

Question 2

Consulting Providers may

Answer 2

recommend care or specific procedures for specific issues OR take over in the place of the initial provider

Question 3

Only coded if

Answer 3

*initiated by physician or other appropriate source NOT by the patient or family

Question 4

May be performed in

Answer 4

*office, outpatient, and inpatient settings
*

Question 5

Procedures performed during or after consult coded

Answer 5

separately using appropriate procedure codes.

Question 6

If mandated by a third party

Answer 6

use modifier 32 in addition to the consult procedure code.

Question 7

CONSULTS:

*95 MINUTES OR LONGER (Inpatient or Observation Consultation)

Answer 7

PROLONGED SERVICES Code: 99417
for each ADDITIONAL 15 MINUTES of TOTAL TIME

*Should ALWAYS be used as an ADD-ON CODE to CPT Codes: 99255 and 99245

Question 8

CONSULTS:

*70 MINUTES OR LONGER DURING (Office or Other Outpatient Consultation)

Answer 8

PROLONGED SERVICES Code: 99417
for each ADDITIONAL 15 MINUTES of TOTAL TIME

*Should ALWAYS be used as an ADD-ON CODE to CPT Codes: 99255 and 99245

Question 9

Coding Quick Reference Chart