Wiki inpatient coding

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lisatf

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I work in a gastroenterologists office, three mds, and one pa. i am having my inpatient coding denied by insurances. i am using 99222-99224. the message from insurance companies is that i cannot use 99222 if another md, not in our practice, has admitted this patient. i have been using this code for many years and have not had a problem. is this a new coding guideline? if so can you inform me where i can get this information.
 
There is definitely some conflicting advice on this, depending on who is giving the advice.
When CMS did away with consult codes, they advised multiple physicians could bill for 99221-99223. The admitting should use -AI.
"Effective January 1, 2010, the consultation codes are no longer recognized for Medicare Part B payment. Physicians shall code patient evaluation and management visit with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysicians where permitted) who perform an initial evaluation and management may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304-99306). As a result of this change, multiple billings of initial hospital and nursing home visit codes could occur even in a single day."
Not all commercial carriers follow this same guidance. You would need to contact the specific insurance for their policy regarding this. Almost all my contracts specify coding is following CMS guidance and will pay multiple 99221-99223.
Every once in a while, I will have an initial visit denied stating it was paid to another physician, which I will appeal with a copy of the Medicare guidelines. If it is still denied, I will then bill a subsequent.
You may want to keep a chart of which carriers permit multiple physicians to bill initial if your carriers do not follow CMS guidelines.
 
Whenever I get this denial I check to see if the payer still accepts Consultation codes. Because they are saying they do not want two initial E&Ms on the same day, it leads me to believe that they are looking for a different code set for providers who perform consults.

I work in New York and have found that WC/NF carriers in NY still accept consult codes, as well as NYS Medicaid, Amerigroup Medicaid and Aetna Commercial Plans.

Different states will have different fee schedules so I recommend contacing the payer and asking if they are still using consult codes 99241-99255, and then updating to the consult code if they still do.
 
At least for the last few years, CPT guidelines state "For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate". Only the actual admitting physician should be billing 99221-99223.
 
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