Question Consult codes

Messages
2
Location
Waynesboro, MS
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0
So I've only been coding for 5 months and I'm still a little confused on a few things so here's my first question. If a patient comes in w/ commercial insurance and is referred by another specialty doctor ( that's not from our clinic) is 99241-99243 appropriate to use or 99201-99203?
 

Chelle-Lynn

True Blue
Messages
729
Location
Modesto, CA
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0
That would depend on the insurance carrier. Some carriers are following the Medicare guidelines and not allowing for consult codes. Others have not adopted the policy and still is allowing for them. I would recommend that you check with your contracts division or Business Office Manager to help you determine the policy for your office.

Some offices have adopted the no use of 99241-99243 to simplify the process.
 

sparksbe

New
Messages
2
Location
Huntington, WV
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0
My office is located in WV and I was wondering if anyone knew which insurance companies allowed office consult codes. I know in our area that commercial blue cross does but that is the only one i can find.
 

pogiest

Guru
Messages
218
Location
Jacksonville Florida Chapter
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0
You should double check me, but in general, I know the following do not pay for consult codes: Aetna, AVMED, Cigna, Department of Labor, Kaiser, Medicare, Medicare Replacement Plans, Medicaid, Meritain, United Health Care, UMR, and Tricare.

Again, you should double check me with your local insurer, especially with the commercial carriers.

To make things easier on us (because we are only two in the billing department), we have adopted a no use policy since few of the insurers we accept allow consult codes.
 

Orthocoderpgu

True Blue
Messages
1,482
Location
Salt Lake City, UT
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7
My question is, are you meeting all three documentation requirements in order to bill a "consultation". You may not be aware but CMS reviewed "consultation" documentation for three years. For all three years 95% of the documentation did not support a consultation. Coders were using them incorrectly which is why CMS stopped paying them and private insurance has followed. Before you actually bill a consultation make sure that all three requirements are in the documentation.
 

csperoni

True Blue
Messages
811
Location
Selden
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2
Agree with both above.
1) Make sure you meet the 3 "R"s for consult
2) My unofficial list for those that do not allow consult codes:
Aetna, Amerihealth, Amida Care, BCBS HealthPlus, BCBS Medicare, Centerlight, Cigna, Elderplan, Fidelis, HealthFirst, HIP, HealthCare Partners, Humana, Medicare, Medicaid, Metroplus, MVP, Oxford, Quality Health Plan, Touchstone, United Healthcare, United Healthcare Community, VNS, Wellcare.
We have also adopted a policy of not using consult codes.
If you do meet the requirements and will be billing consult codes, your billing software likely has a module where you can build a rule so if you enter a consult for an insurance that you previously confirmed does not accept consult, it will hit an edit and you can correct before it goes out.
 
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