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Topics in Practice Management |

Consultations After Elimination of Payments for Evaluation and Management Consultation Codes

Seth A. Hoffman, MD, FCCP; Scott Manaker, MD, PhD, FCCP
Author and Funding Information

From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

Correspondence to: Seth A. Hoffman, MD, FCCP, Division of Pulmonary, Allergy, and Critical Care Medicine, The Penn Lung Center, 1-West Perelman Center, 3400 Civic Center Blvd, Philadelphia, PA 19104; e-mail: Seth.Hoffman@uphs.upenn.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):933-938. doi:10.1378/chest.10-1340
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A consultation service provides expert opinion or advice at the request of another provider. The Centers for Medicare and Medicaid Services (CMS) eliminated reimbursement for the outpatient and inpatient consultation codes traditionally used to report these services (CPT 99241-99245 and 99251-99255, respectively), and private payers are likely to follow suit. CMS has instead mandated that these services are mapped to new or established visit codes for outpatients (99201-99205 or 99212-99215) and to initial or subsequent hospital services codes for inpatients (99221-99223 or 99231-99233). This article reviews appropriate medical consultation and provides specific guidance for the reporting of these services to CMS and other payers not reimbursing consultation codes.


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