Wiki NP Hospital Billing for Consult Visit

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lgarcia96

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Hello,
I work an Oncology clinic - our Doctor's go to the hospital to see patients with help from an NP. There is this recent dos that the NP did a consult visit alone. I believe I can not bill the consult visit (99222) alone because the Dr did not attest to the visit. Is that correct? I usually bill the shared visit when both have documented that both seen the patient. Unfortunately, on this note it's just our NP. Please advise
 
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Are you sure you are using the correct code set? Most insurance companies no longer consider consult codes for benefits any longer. Just because your doctor goes to the hospital, that does not mean a consultation is being performed. Three separate requirements must be met in order to bill a consult code.
 
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Orthocoderpgu said:
Are you sure you are using the correct code set? Most insurance companies no longer consider consult codes for benefits any longer. Just because your doctor goes to the hospital, that does not mean a consultation is being performed. Three separate requirements must be met in order to bill a consult code.
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I added the initial admit code (99222) - we are aware we have to bill this in place of the consult code range (99251-99255). In our office we still call it "consult" even though we bill it with the initial codes.
 
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lgarcia96 said:
I added the initial admit code (99222) - we are aware we have to bill this in place of the consult code range (99251-99255). In our office we still call it "consult" even though we bill it with the initial codes.
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Do you have access to the Webinars? The most recent one is on split/shared visits performed in a facility. For 2022, the provider that performed the most work would bill the service. It sounds like the NP performed 100% of the visit, but the MD did not sign the documentation. If that information is accurate, then the visit would be billed under the NP regardless. If you have access to the Webinars, check it out.
 
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Agree with advice above by @Orthocoderpgu
Your office may call this a consult, but it is likely not a consult by coding definitions. If 99222 is the appropriate level for the service provided, and it was provided by the NP, whether or not the MD signed it, it is billable only under the MD.
PS - coders should be very careful about the use of the word consult, particularly in a coding forum. In coding, consult has a very specific definition, and so many people ignoring that for years is why consult codes no longer exist (for Medicare and almost every commercial carrier).
If you have hospital visits being provided as split/shared, you should carefully review the 2022 requirements as well as the upcoming 2023 requirements. Most clinicians will need to change the way they have historically documented.
 
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