In Patient Consult - Medicare Primary

lapcpc

Networker
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46
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I know that Medicare no longer accepts the consult codes. However, one of our physicians did an in patient consult and the patient has medicare primary. Would like thoughts on what code would be most appropriate to bill for this consult.

Thanks for any help!!

Lori
 

cmartin

Guru
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204
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I believe they refer you to the initial in-patient care codes, which ordinarily would only be used on admission, for in-patient consults now.
 

RebeccaWoodward*

True Blue
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3,126
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North Carolina
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I know that Medicare no longer accepts the consult codes. However, one of our physicians did an in patient consult and the patient has medicare primary. Would like thoughts on what code would be most appropriate to bill for this consult.

Thanks for any help!!

Lori
"In the inpatient hospital setting and the nursing facility setting, physicians (and qualified nonphysician practitioners where permitted) may bill the most appropriate initial hospital care code (99221-99223)"

"In the office or other outpatient setting where an evaluation is performed, physicians and qualified nonphysician practitioners shall use the CPT codes (99201 – 99215) depending on the complexity of the visit and whether the patient is a new or established patient to that physician. All physicians and qualified nonphysician practitioners shall follow the E/M documentation guidelines for all E/M services. These rules are applicable for Medicare secondary payer claims as well as for claims in which Medicare is the primary payer"

Pages 61/62

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//clm104c12.pdf

Guidance for other place of services can found in this manual, too.
 
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