Medicare did drop 9925 codes and consolidated the other codes, Medicare pays 99221- 99223 consult codes as our Neurosurgeons see patients daily in the Hospital as well as pay for Office Consult codes.Well, most insurance companies dropped consult codes when Medicare did, so if they're accepting them at all, it's a miracle.
yes, we know that some follow CMS and some follow AMA. But is it appropriate for them to make up their own rules??Each payer establishes their own policies pertaining to billing rules. Some follow CMS's guidance, but there are a lot that don't.
99221-99223 are not consult codes, they are "initial hospital care for a new or established patient". They may be the codes you are using when you are called "to consult", but they are not technically consult codes.Medicare did drop 9925 codes and consolidated the other codes, Medicare pays 99221- 99223 consult codes as our Neurosurgeons see patients daily in the Hospital as well as pay for Office Consult codes.
It depends on what 'rules' you are talking about. There are some rules that are federal mandates that must be followed by all plans (e.g. under HIPAA, what code sets are allow to be used in electronic claims submissions; or under the ACA, which preventive benefits must be covered in full). There are also state laws that govern payment for plans offered by insurance companies that operate within that state. But then there are payment policies and coverage guidelines, which each plan or payer is free to set up for their own company or plans as long as they stay within the law.yes, we know that some follow CMS and some follow AMA. But is it appropriate for them to make up their own rules??