Wiki Psych MD and Consults

[jgarcia619]

I work for a Hospice and we have psych MD that used consult codes. Now that these are eliminated, they have questions. I was wondering if anyone could help. His questions are:

1. Do the old rules apply, but we now just use different codes to bill consults or do we use the rules for the e/m codes now used for consults

a. For example, getting documentation of the consult request, no shared e/m billing for consult codes)

2. Can we, as psychiatrists, still bill a new (as opposed to established) e/m code for consultations despite the patient being seen by another physician (Palliative Med) from the same practice as we could under the old rules?

 

[LLovett]

Ok, there are tons of threads on this and still lots of lovely shades of gray but I will answer to the best of my knowledge for today.

1. Do the old rules apply, but we now just use different codes to bill consults or do we use the rules for the e/m codes now used for consults

For Medicare patients (and any carriers following Medicare guidelines) consults no longer exist, throw out the guidelines. Everyone is either new or established or on the inpatient side they are an initial visit. There is also the option of ER codes if you are seeing them in the ER.

a. For example, getting documentation of the consult request, no shared e/m billing for consult codes)

The only rules that should apply now are those of the code set you are using. If a code could be used for a split/shared E/M before it still can now. I know I see that CMS has indicated documentation should not really change (ie reports back) but I have not seen that requirement added to any of the other codes and I would think it would be impossible to enforce. How do you tell between a regular new patient or someone who would have been a consult? I could go so far into that issue but I won't. We'll just leave it at "its flawed".

2. Can we, as psychiatrists, still bill a new (as opposed to established) e/m code for consultations despite the patient being seen by another physician (Palliative Med) from the same practice as we could under the old rules?

As long as they are credentialed as a different specialty, yes this has not changed.

As I said this is to the best of my knowledge for today, it could change at any given moment. I would suggest checking with your local carrier about any education they are putting out there. WPSMedicare and HighmarkMedicare are both doing E/M education next month if one of those is your carrier great, if not it still gives you some CEUs and more info.

Laura, CPC, CPMA, CEMC