Medicare consult for domiciliary, rest home, assisted living visits

[SUEV]

If a doctor is asked by an appropriate source to do a consult on a patient in the above settings, what codes should we use to bill Medicare? Do we just use the 99324-99337 codes or do we use the 99201-99215 codes? Outpt Consult codes 99241-99245 can be used for these settings but will Medicare process 99201-99215 with POS 13 or 33? I have not been able to find guidance from CMS specifically for these locations and since the rules regarding Inpt (use Inpt codes) vs. Obs (use Outpt codes NOT Obs codes) vs. ER (use ER codes) consult code choices are different, I'm hoping someone knows.
Thank you for any advice you can give,
Sue

 

[Cynthia Hughes]

Use the E/M appropriate to site of service for consultations

Hi,

One of the Q&A's in MLN Matters article SE1010 addesses this and instructs to bill according to the category of E/M appropriate to the site (in this case, domiciliary etc.). A link to SE1010 is below.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se1010.pdf

I hope that helps.
Cindy

 

[SUEV]

Thanks for the link Cindy. I had seen it but didn't understand why they would say "report the most appropriate available code to bill Medicare for services that were previously billed using the CPT consultation codes" but then require Outpatient codes for Observation patients instead of the Observation admission and subsequent visit codes. I was wondering if other sites had similar exceptions. Since I can't find any, I'll use this article as my reference.
I appreciate your response
Sue