New Patient, Established Patient, Office Consultation visit?
A consultation is a type of service provided by a physician whose opinion or advice regarding Evaluation and Management (E/M) of a specific clinical problem is requested by another physician or other appropriate source. CPT consultation guidelines further define an “appropriate source” as health care professionals (i.e. Physician, Nurse Practitioner, Certified Nurse Midwife, etc.).
If an additional request for an opinion or advice regarding the same or a new problem is received from another physician or other appropriate source and documented in the medical record, the office consultation codes may be used again. The office/outpatient consultations codes would be (99241-99245).
Note: If the payer does not accept the consultation codes, you would need to do a “crosswalk” to a new or established patient code (99201-99205, 99211-99215). Below is a decision tree to help determine which category would be appropriate in that event.