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End of Consultation Codes?

  1. #11
    Location
    North Carolina
    Posts
    3,126
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    Medical Coding Books
    In the absence of Congressional action for the CY 2010 physician update, the final rule with comment period will reduce the conversion factor for services on or after Jan. 1, 2010 by 21.2 percent rather than the -21.5 percent projected in the proposed rule....

    I imagine this will effect more than just specialist...

  2. Default Modifier?
    This is the first I've heard of a new modifier. Where did you find documentation to support that.
    adrianne, cpc

  3. #13
    Location
    North Carolina
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    3,126
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    Because of an existing CPT coding rule and current Medicare payment policy regarding the admitting physician, we will create a modifier to identify the admitting physician of record for hospital inpatient and nursing
    facility admissions.
    For operational purposes, this modifier will distinguish the admitting physician of record who oversees the patient's care from other physicians who may be furnishing specialty care. The admitting physician
    of record will be required to append the specific modifier to the initial hospital care or initial nursing facility care code which will identify him or her as the admitting physician of record who is overseeing the patient's care. Subsequent care visits by all physicians and qualified NPPs will be reported as subsequent hospital care codes and subsequent nursing facility care codes.

    http://www.federalregister.gov/OFRUp...9-26502_PI.pdf

    Page 178

  4. #14
    Location
    Charm City - Baltimore
    Posts
    103
    Default
    OK - so I just wanna get this straight. The new Modifier AI is for the ADMITTING DOC - regardless of specialty. I work for ortho and the attending will call our docs to consult and then our docs admit. So I would append the AI?

    This is going to be terrible. Has anyone heard about what to do when Medicare is Secondary?
    Crystal, CPC, CCS-P

  5. #15
    Default
    robo50,

    CMS put out a three page explanation regarding the consultation codes and payment policy on 12/14/09 MLN Matters# MM6740, CR Transmittal# R1875CP. Hope this helps I have a printed copy in my hands.

    ~Roxanne

  6. #16
    Default
    Forgot to tell you guys the modifier that will be used for the primary attending physician will be AI

  7. Default
    Does anyone know how I would code an ER consultation by a Psychiatrist beginning 1/01/2010 for a M/C patient?

    We previously used 99241-99245 but now we're to use 99201-99215; how would this work considering the fact that the office/other outpatient codes are seperated by New and Established patient?...

    Please advise.

    Thanks,

    Gloria T, CPC
    New York

  8. #18
    Location
    Milwaukee WI
    Posts
    4,466
    Default ER "consult" 2010
    Quote Originally Posted by GTRINIDAD View Post
    Does anyone know how I would code an ER consultation by a Psychiatrist beginning 1/01/2010 for a M/C patient?

    We previously used 99241-99245 but now we're to use 99201-99215; how would this work considering the fact that the office/other outpatient codes are seperated by New and Established patient?...

    Please advise.

    Thanks,

    Gloria T, CPC
    New York

    You code the appropriate level ER visit based on documentation.

    F Tessa Bartels, CPC, CEMC

  9. #19
    Location
    Ellenville, New York
    Posts
    1,176
    Default
    Only the ER physician can use 99281-85. For ER consultations, either the outpatient or inpatient codes may be used, depending on if the patient is admitted or discharged from the ER.

    Also, there is still a possibility that the 21.2% reduction in the payment rate may be retracted. The Senate HC reform bill had this language to repeal the SGR method of determining the conversion factor, which was the reason for the decrease. If the compromise bill contains this amendment, the reduction will not take place.

  10. #20
    Location
    Ellenville, New York
    Posts
    1,176
    Default
    Quote Originally Posted by CrysLednum View Post
    OK - so I just wanna get this straight. The new Modifier AI is for the ADMITTING DOC - regardless of specialty. I work for ortho and the attending will call our docs to consult and then our docs admit. So I would append the AI?

    This is going to be terrible. Has anyone heard about what to do when Medicare is Secondary?
    Check out this document from MLN - MLN Policy #JA6740. Basically, if MCR is secondary and the primary payer still pays for consultation services, there are two choices.
    One: the claim can be submitted to the primary with the consultation code, then the code must be changed to the appropriate OV or inpt E/M code before sending it to Medicare.

    Two: The appropriate OV or inpt E/M code can be submitted to the primary and then MSP will get the claim after the primary pays. Our practices are going this route - determined the difference between the "regular" E/M and consultation reimbursement was not worth the extra work to change MSP claims.

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