CPT Publishes Guidance for Consultation Coding

CPT just released an informational memo addressing consultation services and transfer of care. Much of the memo will not apply for Medicare patients since CMS is no longer accepting consultation codes. The memo suggests that Medicare contractor websites are the best place to locate further coding inforamtion for Medicare patients.

Unfortunately, a lack of direction from CMS to contractors has resulted different solutions for reporting low-level inpatient consultations. Until more specific guidance from CMS is given, adhere to the key elements of the service provided when selecting the appropriate code. For example, level 3 inpatient consultation (99253) requires detailed history, detailed exam, and low complexity decision making. This matches exactly with level 1 inpatient hospital care (99221), which requires detailed history, detailed exam, and low complexity decision making.