Wiki 99223

[heart123]

can someone please tell if they get paid for 99223 as a consult
Dr did not admit i would have put 99223 AI
is this correct

 

[trarut]

Only the admitting or attending physician should use the AI modifier. If your physician was request to consult, you should not report the AI with the E/M code.

 

[heart123]

yes im sorry the only time i use AI is if they admit
i was trying to find out if my dr does not admit but does a consult can i use 99223 without and AI
and will it get paid

 

[trarut]

If your doctor doesn't admit, you can't use the AI modifier. Resubmit without the AI. No guarantee you'll get paid - there's never a guarantee of payment but no modifier is the correct way to submit.

 

[SharonCollachi]

Some insurance companies will only accept 99223 from the admitting physician, with or without a modifier. If the insurance company won't accept it, you should use 99231-99233.

 

[heart123]

i guess im not explaining my question right,
My Dr does a consult in the hospital I know i cant use 99254 for some insurance sooo
can i use 99223??? hope i explained it better lol
Thanks

 

[thomas7331]

i guess im not explaining my question right,
My Dr does a consult in the hospital I know i cant use 99254 for some insurance sooo
can i use 99223??? hope i explained it better lol
Thanks

For the payers that do not accept the consultation codes, you can use the inpatient codes 99221-99223, assuming the documentation requirements have been met. (99254, which only requires moderate MDM, would usually translate to 99222 since 99223 requires high MDM which would be a 99255 as a consultation code.)

Here's the complete guidance Medicare issued following their decision to no longer accept consultation codes:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6740.pdf

 

[heart123]

Wow i am still confused im sorry first they say this which makes me think i can bill a 99223 for a consult
The principal physician of record will append modifier “-AI” Principal Physician of Record, to the E/M code when billed. This modifier will identify the physician who oversees the patient’s care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed. • However, claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or outpatient codes) will not be rejected and returned to the physician or provider.
is it just me ??? or is this confusing

 

[SharonCollachi]

I think it's just you.

There are some insurance companies that will ONLY pay the admitting physician for 99221-99223.

There are some insurance companies that will pay ANY physician for 99221-99223.

So, if the insurance company you are dealing with will ONLY pay the admitting physician for 99221-99223, you would use 99231-99233 instead.