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Elimination of Consult Codes

  1. Default Elimination of Consult Codes
    Medical Coding Books
    I heard that Medicare finalized a rule on 11/6 that eliminates the office and hospital codes (99241-5 & 99251-5). These will now be coded using initial office and hospital admission codes (99201-5 & 99221-3). I work for a specialist whose practice is largely consultant based, and my head is spinning.

    How should consults now be crosswalked for Medicare? For instance, if my doctor did a 99254 consult, what would be the corresponding code? I'm uncomfortable thinking in these terms as I'm used to thinking more in terms of guidelines, but are there official guidelines out there for this somewhere?

    Thanks,
    Kim, CPC

  2. Cool Medicare and consults
    Hi,
    I have not heard that Medicare is not paying for consultations. I just searched the medicare website and didn't see anything there either. Where are you getting this info??

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Initial Hospital Visit
    I believe Medicare has stated that it will accept the Initial Hospital Visit code from multiple providers to document each physician's FIRST visit with a patient during a specific hospitalization.

    99254 requires a Comprehensive History, Comprehensive Exam, and Moderate MDM, so that would equate to 99222. I believe Medicare is also going to specify a modifier to be used to identify the "consulting" specialist vs the admitting physician, but I haven't seen any specifics on that yet.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 11-10-2009 at 02:59 PM.

  4. #4
    Location
    North Carolina
    Posts
    3,126

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    I'm starting to receive questions like...

    Consultations could not be shared in the past. Since it appears that consultations will be reported with admission codes...can these, now, be shared since admissions can be shared... (doubtful)

    For those consultations that don't meet detailed/comprehensive history, exam, etc....what do you report?

  6. #6
    Default
    It certainly is opening a can of worms.

    I am trying to think of it in terms of there are no consults anymore (well after 12-31-09) and just treating them like I would any admit(aside from the fact more than one provider will be able to use this code now). If they don't meet the requirements for 99221-99223 (which would be anything currently billed as 99251-99252) I use 99499. We are re-emphasizing the key components of the admit codes to all our providers. Many specialist rarely do them so this will be a pretty drastic change for them on the inpatient side.

    On the bright side, you don't need a request, you don't need a report back, and you don't have to worry about using the right verbiage!

    Laura, CPC, CEMC

  7. #7
    Default
    The HCPCS modifier is going to be AI for the admitting physician of record to report. All others (consultants) will just report initial visit codes for their first visit in the hospital.

    This is going to be an interesting ride for coding between all the different payors. Anyone heard of any other payors eliminating consults?
    Kelly G.

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by katmryn78 View Post
    It certainly is opening a can of worms.

    I am trying to think of it in terms of there are no consults anymore (well after 12-31-09) and just treating them like I would any admit(aside from the fact more than one provider will be able to use this code now). If they don't meet the requirements for 99221-99223 (which would be anything currently billed as 99251-99252) I use 99499. We are re-emphasizing the key components of the admit codes to all our providers. Many specialist rarely do them so this will be a pretty drastic change for them on the inpatient side.

    On the bright side, you don't need a request, you don't need a report back, and you don't have to worry about using the right verbiage!

    Laura, CPC, CEMC
    I normally would too (99499) for those "out of norm" visits but this doesn't make sense to me for 99251/99252. 99499 is an unlisted code without a designated fee. Does this mean that any 99251/99252 is subject to review, everytime, to determine payment?? I hope not....

  9. #9
    Default elimination of consult codes
    Quote Originally Posted by rebeccawoodward View Post
    I'm starting to receive questions like...

    Consultations could not be shared in the past. Since it appears that consultations will be reported with admission codes...can these, now, be shared since admissions can be shared... (doubtful)

    For those consultations that don't meet detailed/comprehensive history, exam, etc....what do you report?
    Here's another question, how will we know who was actually asked to consult and who just entered the wrong code? My Docs all the time enter the wrong code and I have to go back and ask them if they admitted the patient on this date?, it might be two or three days into the hospital stay, they say "oh, no, that's wrong". Now, how will we know to check? Is there going to be a tracking mechanism for us to know who was actually a consultant? I think the modifier should go on the consult codes myself, but that's just my opinion!
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  10. #10
    Location
    Evansville Indiana
    Posts
    451
    Default Modifier AI
    Where did you see the information about the AI modifier? I haven't been able to find anything on this. I am writing an article about the changes for our physicians and would like to reference this.
    Thanks

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