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24.3.12.6 Consultations
A consultation (procedure codes 3-99241, 3-99242, 3-99243, 3-99244, 3-99245, 3-99251, 3-99252, 3-99253, 3-99254, and 3-99255) is an E/M service provided at the request of another provider for the evaluation of a specific condition or illness. A consultation must consist of the following in order to be billed as such:
• There must be a request from the referring provider for the evaluation of a particular condition or illness.
•There must be correspondence from the consulting provider back to the referring provider indicating the medical findings.
During a consultation, the consulting provider may initiate diagnostic and therapeutic services if necessary. If treatment is initiated and the patient returns for follow up care, an established patient visit should be billed. If the purpose of the referral is to transfer care, a consultation may not be billed.
The medical records maintained by both the referring and consulting providers must identify their counterpart and reason for consultation.
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