Wiki Need Help W CONSULT code(s)

[aikido22]

If you do not have the formal consult request (99251-99255), do you down code to 99221 -99223, etc or do you downcode to the subsequent visit 99231 -99233 etc?

Also, this is for non medicare insurance**
I know for Medicare patient's we only use code 99221-99223.

 

[FTessaBartels]

Yes

Well, the answer to your question depends on several factors.

If the patient is covered by Medicare (or a carrier who is following CMS guidelines re consults), then you code based on whether this is the FIRST inpatient visit or a subsequent inpatient visit.

If the patient is covered by a carrier who accepts the consultation codes, then you have to code as subsequent (because those carriers only accept ONE initial hospital visit code, from the admitting physician).

Hope that helps.

F Tessa Bartels, CPC, CEMC