Wiki Consult Clarification


Pendleton, IN
Best answers
Please help. Just when you think you have total comes the wrench
We are a Hematology office that 9 times out of 10 is being called to "consult" on one of our own patients. My understanding is that the 99221-99223 is to be used to admitting physicians only OR if the patient is Medicare and then if we are the admitting it gets the AI modifier. If we are not the admitting physician and the patient is one of ours we then use subsequent care codes. The kicker question being that if we come in and "consult" or give advice on a new patient and "back away" from the patient's care would it not be a consult if they are non-Medicare?

Thanks for all the help!
If your provider is called to do as consult but is not the admitting Dr. you can bill a 99221-99223 for the consult, what separates you from the admitting physician is the AI modifier.