The Centers for Medicare & Medicaid Services (CMS) recently updated its requirements for reporting consultation services provided to Medicare patients. Effective with services provided and billed to the Medicare program on January 1, 2010, and after, the CMS directs a consulting physician to report the most appropriate available evaluation and management (E/M) code in lieu of reporting Current Procedural Terminology (CPT®) consultation codes 99241–99245 and 99251–99255.

Following initiation of the reporting guidelines, it was recognized that the required key components for the lower-level inpatient hospital consultation codes (99251 and 99252) are not equivalent to the lowest-level initial inpatient hospital care code 99221 (Table). Therefore, the CMS revised the Medicare reporting guidelines for reporting inpatient hospital consultations. Those guidelines state that if the requirements for reporting code 99221 are not met, physicians should report subsequent inpatient hospital care services if the level of service performed and documented...

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