In Billing
Mar 9th, 2015
Medicare will not pay for consultation codes (except telehealth consultations), and requires that consultations services be billed with the most appropriate (non-consultation) E/M code for the service. Note: Other non-Medicare payers may allow you to continue to report Consultation codes. Check with individual payers for guidelines. Outpatient consultations for Medicare Beneficiaries should be repo...
Jul 1st, 2013
CMS says to use E/M codes to report these services, but you’ll have to play by their rules to get paid. By G.J. Verhovshek, MA, CPC, Medicare stopped accepting claims for outpatient (99241-99245) and inpatient (99251-99255) consultations as of Jan. 1, 2010, but physicians haven’t stopped providing these services. How are they getting paid? After ...
In Audit
Oct 14th, 2011
A widespread probe review recently conducted by TrailBlazer Health Enterprises, LLC for initial hospital care codes reported to Medicare resulted in an overall error rate of 58.31 percent, confirming the jurisdiction 4 Medicare administrative contractor’s (J4-MAC’s) suspicions of potential improper use. TrailBlazer Identifies Improper Use of Initial Hospital Care Codes was last modified: October ...
In CMS
May 1st, 2010
Heated coding discussions seek resolution to unanswered questions. By Karen Pettit, BBA, CPC, CMC, and G. John Verhovshek, MA, CPC As you are probably well aware, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes CPT® consultation codes 99241-99245 (outpatient) and 99251-99255 (inpatient), effective Jan. 1. This policy change was discussed in January’s ...
May 1st, 2010
By Kerin Draak, MS, WHNP-BC, CPC, CEMC, COBGC Providers of long-term care services must comply with several different regulating criteria, and it is the coder’s responsibility to understand applicable rules when coding these unique services. In recent years, there have been extensive changes in the Nursing Facility Services section of the CPT® manual. Although this ...