Medicare Compliance & Reimbursement

Hint: Only look to unlisted E/M codes when your MAC specifically tells you to. How did you fare in our E/M coding quiz on page 21? Check your coding finesse with these four answers to the quiz questions. Answer 1: Consult 'Replacement Codes': If the physician performs a service that you previously would have billed as an inpatient consult, report 99221-99223 in place of 99251-99255, says Tammie L. Alberts, CPC, with Rockford Health Systems in Rockford, Ill. For outpatient consults, use either new or established E/M codes 99211-99215 or 99201-99205, she advises. Answer 2: Do Unlisted Codes Apply? Unless the advice comes from a Medicare carrier, "I would be very cautious about using an unlisted E/M code," says Shelby Davidson, CPC, CMSCS, coding educator with Ohio Health. "If the patient is considered an inpatient, you simply report an initial inpatient visit or a subsequent inpatient visit," Davidson says. "Before I [...]