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Elimination of Consult Codes

  1. #11
    Medical Coding Books
    Ingenix had Coding Circle Elink that mentioned the AI(Principal physician of record) modifier to append to the initial hospital care code by the attending physician.

    If you don't have a login you would have to create one.

  2. #12
    Default Just to add to the chaos..
    I see the comment about just Medicare. Keep in mind CMS is actually the Centers for Medicare and Medicaid Services. Where Medicare goes Medicaid tends to closely follow.

    I checked with Michigan Medicaid today, they have not officially received anything but they expect to get something soon stating they will be following the directive to no longer pay for consults either.

    Which makes sense to me, you would see not Medicaid fee schedules addressed in the Federal Register because they are run by the states, but it ultimately benefits the carriers to drop the consults why wouldn't they go with it.

    Something to keep in mind and watch for,

    Laura, CPC, CEMC

  3. #13
    North Carolina
    Double coverage should prove interesting as well...

    Medicare Prim/Non-Medicare 2ndry versus Non-Medicare prim and Medicare 2ndry.....

    "Some payers may choose to adopt this policy subsequent to this final rule. In cases where other payers do not adopt this policy, physicians and their billing personnel will need to take into consideration that Medicare will no longer recognize consultation codes submitted on bills, whether those bills are for primary or secondary payment.

    In those cases where Medicare is the primary payer, physicians must submit claims with the appropriate visit code in order to receive payment from Medicare for these services. In these cases, physicians should consult with the secondary payers in order to determine how to bill those services in order to receive secondary payment.

    In those cases where Medicare is the secondary payer, physicians and billing personnel will first need to determine whether the primary payer continues to recognize the consultation codes. If the primary payer does continue to recognize those codes, the physician will need to decide whether to bill the primary payer using visit codes, which will preserve the possibility of receiving a secondary Medicare payment, or to bill the primary payer with the consultation codes, which will result in a denial of payment for invalid codes."

  4. Unhappy
    Hi. I too heard about the elimination of 99241-99245. The new codes become 99201-99205. Hospital codes become 99221-99223. My question is this....I work for HEM/ONC and we see new patients in the office all the time in "consultation". What code (I used to use 99243-44-45) will I use in the office setting?

    Hopefully there will be a decline in the the medicare cuts to oncology practices.

  5. #15
    You will either use the new 99201-99205 or established 99212-99215 depending on the patients status with the group/specialty.

    Consults and new patients require the same key components for the same level. So your 99243 would be a 99203 or if they are established with the practice a 99214. Your 99244 would be a 99204 or a 99215, and the 99245 would be a 99205 or 99215.

    Laura, CPC, CEMC

  6. #16
    Central Pittsburgh
    The Federal Register showed a bit of a crosswalk, but discussed that a cross walk is not necessary if you are following the guidelines (which is true).

    If you have a detailed history, a detailed exam, and a moderate decision-making, you can determine which code is most appropriate for your situation (99204 for a new patient, 99214 for an established patient, 99221 for an initial inpatient and a 99233 for a subsequent visit in the hospital.

    Medicare as secondary payer does add a layer as they will not pay for consultations. However, getting information from your top payers as to how they are going to handle consultations should help.

  7. #17
    Correction to the last post, Detailed history, Detailed exam, Moderate MDM is not a 99204 it is a 99203.

    Laura, CPC, CEMC

  8. Default I'm confused -- is this official now?
    I know there's been a lot of speculation about the discontinuation of the consultation codes but is this now official? Since when? I haven't heard anything and can't find anything on the CMS website. Can anyone provide links to the announcement?

  9. #19
    North Carolina
    Not speculation anymore...

    The link below provides the links to CMS and the Fed Regs...

  10. #20
    Seacoast- Dover New Hampshire
    I am very interested in the modifier also. Where did you get this information. I have not seen anything in CMS.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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