Very unlikely you would be meeting requirements for 99255 even if you were able to use it. Medicare stopped recognizing the consultation codes in 2010, and most insurers followed suit by 2020. In my area only medicaid recognizes it. Keep it simple and do 90792 for new consults (which btw is worth 4.16 wRUVs if on new system, more than 99255). You use inpatient f/u codes (99231-99233) for follow ups which are worth 0.76, 1.39 and 2 wRVUs respectively. You can use psychotherapy add on codes in the consult setting where appropriate. The hospital probably isn't collecting on most of this work. When I did consults, we only collected 18% of the time. The bougie hospital collected 40% of the time, and that is recognized as much higher than nationally.
In my view consults does not work on an RVU basis. Where I worked, I argued against having an RVU system for consults and the hospital went for it. There should be no productivity requirement for consults. Unfortunately, this may also impact your income potential compared to other areas unless they happen to pay well for covering consults. But good consult work includes lots of time that is not readily billable, and the workflow is too variable. It should either be straight salaried, or an hourly rate for consults. Can also consider a rate per new and follow up consult but would generally discourage this unless seeing consults is on top of inpt/outpt work.
