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Elimination of Consult Codes

  1. #21
    North Carolina
    Exam Training Packages
    It's in the Federal Regs.....

    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.

    This is not fun reading material but it provides everything you need to know...

  2. #22
    I would also like to see documentation on the AI modifier, if anyone has it. Thanks~!

  3. #23
    Central Pittsburgh
    Red face
    Quote Originally Posted by katmryn78 View Post
    Correction to the last post, Detailed history, Detailed exam, Moderate MDM is not a 99204 it is a 99203.

    Laura, CPC, CEMC

    Could catch! You are absolutely right!!

  4. Default
    Late on Oct 30th, CMS shocked the medical practice industry with news that consultations would no longer be payable. this would eliminate payment for CPT 99241-99245 and 99251-99255. CMS has marked the consultation codes with a status "I" meaning not valid for medicare purposes. to offset the elimination of those payments, physicians are directed to the new or established patient office vist and subsequent visit codes. which received a two percent increase. at this time it is unknown which insurance payers will continue to pay for consultaions and which payers will mirror this new CMS policy. This information was provided by SVMIC. Kathy

  5. #25
    Midtown OKC
    Default Modifier/Consult info
    Liz H., CPC

  6. #26
    Ellenville, New York
    Default Modifier AI
    Search the CMS cite for the 2010 HCPCS levle II Modifiers - AI will be designated for the admitting physician. Consultants will use the appropriate initial hospital visit.

  7. #27
    Tarrant County, Fort Worth
    CMS pulication dated Dec 14, 2009 states:
    "Effective January 1, 2010, the consultation codes are no longer recognized for Medicare Part B payment. Physicians shall code patient evaluation and management visit with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. In the inpatient hopsital setting and the nursing facility setting all physicians (and qualified nonphysicians where permitted) who perform an initial evaluation and management may bill the initial hospital care codes (99221 - 99223) or nursing facility care codes (99304-99306). As a result of this change, multiple billings of initial hospital and nursing home visit codes could occur even in a single day."

    And I was told my Medicare to use 99201-99205 for new patient "consultations" in the office in place of 99241-99245, as CMS no longer recognizes them either.

    I am in the process of contacting BlueCross BlueShield, Aetna, ect. to see how they are going to respond to this. United Healthcare states they follow AMA guidelines, implying that they will pay on it as long as it is in the AMA CPT book. We'll see.

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