A consultation is an evaluation and management (E/M) service provided at the request of another physician or qualified healthcare professional to offer an opinion or advice about a specific problem. To bill a consult, documentation must include:

• A documented request for the consultation
• The reason for the consult
• The consultant’s evaluation and recommendations
• A report sent back to the requesting provider

This applies to both outpatient (CPT 99242–99245) and inpatient (CPT 99252–99255) settings—if the payer covers consult codes.

But wait! Medicare does not pay for consultation codes. Since 2010, providers must instead use standard E/M codes:

• Outpatient: 99202–99215
• Inpatient: 99221–99223 (initial) or 99231–99233 (subsequent)

Even though consult codes aren’t used, the documentation should still show the consultative nature of the service.

For a deeper dive into the nuances of consultation billing—including how to report consults in inpatient, outpatient, and emergency department settings—be sure to check out our webinar: E/M Coding Essentials: Navigating Inpatient and Outpatient Consultations.