When billing for consultations, what must be done according to CMS?

Billing for consultations requires adherence to specific guidelines set forth by the Centers for Medicare & Medicaid Services (CMS). In the context of consultations, it is important to use the appropriate codes that reflect the nature of the visit and the patient's status.

Utilizing new or established patient office and outpatient codes correctly supports the billing process because it ensures that the report accurately reflects the level of service provided. These categories are defined based on whether the patient is new or has been seen by the provider before, factoring in elements such as history, examination, medical decision-making, and time spent with the patient, among others.

In the case of consultations, the billing process must capture the complexity of the evaluation and the specific details of the consultation being provided. Therefore, referencing new or established patient codes aligns with the criteria for properly billing consultations and reflects compliance with CMS guidelines. This is essential for accurate reimbursement and maintaining professional integrity in coding practices.