Wiki Medicare consultation in observation with problem-focused exam

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Bernadette10

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A podiatry consult was requested for a patient in observation. The note has an EPF history, only a problem-focused exam, and low MDM. Since the insurance is Medicare, a 99241 consult code can't be billed. Can 99201 be billed since this is observation status, and therefore should I use the old EM guidelines and not the 2021 guidelines? If the new guidelines need to be used, 99201 is not billable, so would only G0127 for the nail trimming be billable? Another question - Is this even enough MDM for billing a separate EM code, or should only G0127 be billed even if this was commercial insurance?

Consult to podiatry requested by Dr. X.
History: Patient was admitted by Dr. X for acute renal failure.
Allergies: amlodipine, Avelox.
CBC from the previous day was reviewed.
Exam: Toenails were noted to be thickened, discolored, and brittle with subungual debris.
10 nails were trimmed bilaterally with nail nippers. No bleeding was noted. Patient tolerated the procedure well.
Assessment and plan: Onychomycosis. Recommend OTC Pro Clear Z topical daily to all nail beds.
 
I found a partial answer to this. Thank you, Coding Intel!

Changed office visit rules
In 2021, the documentation requirements for codes 99202—99215 changed. These office and other outpatient codes are used in the office, or in a hospital outpatient department. They are also used by the consulting physician for Medicare patients receiving observation services, which is an outpatient service. The changed documentation rules go with the codes, not with the location where the services provided. That means, a consultant using a new patient visit code for a patient in observation status will select the level of service based on the new CPT documentation rules, not the existing 1995 or 1997 rules.
 
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