Wiki Medicare E/M consultation coding crosswalk?

[prirs1985]

Is there any crosswalk for medicare consultation coding per CMS medicare guideline? If so, please advice.

 

[candyciam]

Not sure if this will help but I use Medicare's E/M tool...you just pick what you are wanting and input your data. Very Easy. Hope this is what you are referring to, and hope that it helps some!

https://www.palmettogba.com/internet/eandme.nsf/New?OpenForm

(has to be in Internet Explorer)

 

[thomas7331]

These are the official guidelines from CMS that I use as a reference for consultation billing to Medicare:

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM6740.pdf

I don't know of a published crosswalk, but some practices create their own based on the guidelines.

 

[prirs1985]

How about consulting code for initial hospital observation and follow up?

 

[mitchellde]

Alternative consultation billing for Medicare is a section in the Medicare Manual. You are to use for Inpatient consults the initial inpatient visit level that matches the documentation of the 3 key criteria. for the follow up in the inpatient setting you use the subsequent inpatient codes. If your initial visit level is denied then you should check with the office of the admitting provider. If they do not use the AI modifier on their initial inpatient level then it is a good bet that your submission will be denied.

 

[prirs1985]

Thank you for your feedback. The patient was admitted as initial observation care and doctor performed initial consulting service. Should we code 99241-99245 for non-medicare patient and 99218-99220 for medicare patient?

 

[thomas7331]

Thank you for your feedback. The patient was admitted as initial observation care and doctor performed initial consulting service. Should we code 99241-99245 for non-medicare patient and 99218-99220 for medicare patient?

Please refer to the link I posted above - your question is answered in the first two paragraphs on page 4.

 

[prirs1985]

Please refer to the link I posted above - your question is answered in the first two paragraphs on page 4.

Thank you for your response. My organization wanted me to assign 99218-99220 for medicare and non medicare hospital observation initial visit. I told them it's not appropriate and they said they never had any audits from insurance company.