Wiki Level of service?

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liherman

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Hello. If a physician "consults" a new or established patient in the hospital (inpatient setting) but does not meet the (2023) requirements for a consult level, is a subsequent visit charged or no visit at all?
Thank you.
 
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MagentaMoon67 said:
Are you saying the physician interaction with the patient doesn't even meet a straight-forward level of MDM or at least 35 minutes ?
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Dictation would support it but am I confused if the 99221-99223 need the 4 R's to meet a consult request.
I keep reading everything about the new guidelines and I think I am just really getting myself confused. (I was told if dictation did not meet a consult, then there should not be a charge.)
 
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liherman said:
Dictation would support it but am I confused if the 99221-99223 need the 4 R's to meet a consult request.
I keep reading everything about the new guidelines and I think I am just really getting myself confused. (I was told if dictation did not meet a consult, then there should not be a charge.)
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The consult would still need to be requested by an appropriate source and requires a written report of the findings and recommendations back to the referring.
 
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MagentaMoon67 said:
I don't see why you would not be able to bill a hospital visit E/M, if the documentation supports it.
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Totally agree. If what the physician is calling a consult from a clinical point of view does not meet the coding definition of consult, it is still a visit. This difference in the clinician's definition vs a coding definition is why consult codes were misunderstood/overused for years and why so few carriers will even acknowledge them.
What if the visit DID meet the 4Rs, but carrier is Medicare? Wouldn't you still bill for the service?
 
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csperoni said:
Totally agree. If what the physician is calling a consult from a clinical point of view does not meet the coding definition of consult, it is still a visit. This difference in the clinician's definition vs a coding definition is why consult codes were misunderstood/overused for years and why so few carriers will even acknowledge them.
What if the visit DID meet the 4Rs, but carrier is Medicare? Wouldn't you still bill for the service?
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Ok. Thank you both for your input. :)
 
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