I am looking for the code to use for an inpatient consultation with a straightforward MDM. Dr spent about 15 min. with patient. I have a 2011 CPT & that code has changed, Encoder Pro is also giving me the same thing. Thanks!
Medicare policy invalidates all consult codes since Jan 1 2010. It does not matter that the code is in the book, it is an invalid code for Medicare, and as a result many other payers have adopted the same policy. You cannot bill a consult code to Medicare and you may not bill the patient any part of it. You must go to the MCM and look up the instructions for consultation billing. Which to summarize is that you must use for inpatient the initial levels or the subsequent levels. and regular new or established E&M for office levels. If you can not meet the criteria for the lowest level of initial inpatient then you will need to use a subsequent level.