Consultations in 2023

Question:

I am putting together E&M Guideline educational information for my providers based on the 2023 changes for reference throughout the year. I did some education in 2022 and now working on the tools. In 2022, I kept hearing that inpatient and outpatient consultation codes were being deleted. However, they are still listed in the 2023 CPT Manual. Are you able to help me?

Answer:

You are correct; the inpatient and outpatient consultation services (i.e. 99242-99245 and 99252-99255) remain valid CPT codes in 2023. Perhaps the point of confusion is that CPT codes 99241 and 99251 were deleted to align the Medical Decision Making (MDM) levels with the levels that were defined in 2021 for the office outpatient codes and the 2023 hospital changes.

Remember, Medicare does not accept consultation codes and nothing changes for Medicare in 2023; the consultation codes in the Medicare fee schedule continue to have an Invalid code status. Some private payors have published guidelines stating they do not allow payment for consultations, but the codes remain current; there are payors who still recognize consultation codes.