Question: Should a consultation code be used if the school requests that a child be seen by the pediatrician?

Answer: Yes, it would be appropriate to use a consultation code. A consultation is a type of service provided by a physician at the request of another physician or "other appropriate source" (including schools, juvenile courts, nurse practitioner etc). In this example, since the school is requesting the consultation, you should use the office consultation codes (99241-99245). These codes are used to report consultations provided in the physician's office or other out-patient facility. It is important for the physician to document the referral source and communicate findings from the visit back to the referral source. The consultation level is determined by the history, examination and medical decision making, plus the time spent face-to-face with the patient. There is no distinction for new or established patients, but typical times for each level can be found in CPT 1999. From a reimbursement standpoint, these codes are usually preferable to the more common E/M codes for office or other outpatient services (99201-99215).

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