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aikido22

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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.
 
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Hi,

You would code it as a 99221-99223. In this case, the type of insurance the patient has doesn't apply because since it cannot be coded as an inpatient consult, then the 99221-99223 codes will apply since it is still an inpatient admission.

I hope this helps.

Kristin Barber, CPC
 
These services are not always on the day of admission. In addition, another provider may be responsible for admitting the patient, in which case he or she (the admitting ONLY) could report 99221-99223. If any other provider is seeing the patient that day, that other "consulting" provider would be required to use 99231-99233. Read the guidelines in CPT around the admission codes. Only a single provider/service can admit/discharge the patient; therefore, 99221 series would tend to be the exception, not the rule.

This is not "downcoding" so much as it is "right coding".
 
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Different view on this

kevbshields said:
These services are not always on the day of admission. In addition, another provider may be responsible for admitting the patient, in which case he or she (the admitting ONLY) could report 99221-99223. If any other provider is seeing the patient that day, that other "consulting" provider would be required to use 99231-99233. Read the guidelines in CPT around the admission codes. Only a single provider/service can admit/discharge the patient; therefore, 99221 series would tend to be the exception, not the rule.

This is not "downcoding" so much as it is "right coding".
Click to expand...

I have a different outlook on this, no disrepect...If the patient has been admitted by the Principal of Record that physician can use the inpatient codes 99221-99223 BUT would have to attach the AI modifier to distinguish him/her as the physician who ordered the admit. Now if a specialist is called to the floor once the patient is in inpatient status, that specialist can bill the appropriate inpatient code 99221-99223. The specialist can also bill for subsequent inpatient visits 99231-99233 throughout the duration of the patients' visit with that specialist. Just my two cents...:)

Reading the previous posts I did see now unofficial consult request and I still feel that the Inpatient hospital codes 99221-99223 w/out the AI modifier because we are the specialist not the admitting Principal of Record.

Is there still commercial insurances that will pay for the consultation visits 99251-99255 and 99241-99245?
 
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I bill for specialist and we bill 99221-99223 for consults in the hospital if the patients insurance does not accept consult codes (there are still a few ins that accept consult codes). If we admit, we add the AI modifier. So we code just like you do dscoder. I thought that was what Medicare instructed everyone to do when they quit accepting consult codes ?????? I believe they also stated that if the documentation did not support using the 99221 -99223 you were to use the subsequent hospital visit codes - 99231 -99233.
 
To get back to the original question... You do not need a formal request for a consultation, only documentation that a request for consult was received. This can be one line stating .. Dr x requested I see this patient regarding........
As far as initial inpatient vs consult, this rule changed in 2010 when Medicare decided that consult codes were invalid. THEY instructed us to use the AI modifier for the admitting provider and the same initial codes for the consults with out the modifier. This is Medicare specific, however many of the other payers have followed along with this rule.
 
It helps to think of the 99221-99223 as initial inpatient visit levels and not as admit levels. So when a consultant sees a patient at the behest of the admitting provider the the first visit by the consultant is their initial encounter in the inpatient setting.
 
With a shared record a formal request for a consultation is not needed. There only has to be reference to the consultation. For example, Dr. Smith notes that he has requested a consult from Dr. Jones. Dr. Jones may also note at the end of his dictation, "Thank you Dr. Dr. Smith for the consultation." Usually you will also see that the records are "C.C.'d" to the referring/consulting physicians.
 
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