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Consults for 2010

  1. #11
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    Medical Coding Books
    Quote Originally Posted by mitchellde View Post
    That is the way I read it!
    Thank you so much!

    Where did you see it on the CMS website? Can you please send me the link.

  2. Default 2010 consult who knows?

    So What if Docs hold the billing because they don't want it to hit the deductible? Also what happens if the Docs that do the initial admit forget to put the modifier? In addition what happens if the doc who is supposed to bill for the admit does not? Are they planning to keep it in review forever?
    What do we do for Commercial and HMO carriers are they going to follow the Medicare rules? What about Medicare HMO's do you or don't you?

    HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  3. Default
    I don't know whether to laugh or cry

    Should the modifier be added on all admits in order to keep the charge from going to review in case a consultant bills their visit first?

    I just see so many problems. I guess the best thing to do is, buckle up and keep hands in the ride at all times

    rinny

  4. #14
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by angela1 View Post

    So What if Docs hold the billing because they don't want it to hit the deductible? Also what happens if the Docs that do the initial admit forget to put the modifier? In addition what happens if the doc who is supposed to bill for the admit does not? Are they planning to keep it in review forever?
    What do we do for Commercial and HMO carriers are they going to follow the Medicare rules? What about Medicare HMO's do you or don't you?

    HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    Yes...I have heard that if the admitting physician fails to append the AI modifier to their claim, all others will be held for review. As for commercial carriers, I have only heard of one that will follow MCR's lead. I have many, many questions too. Waiting patiently for Medicare to publish a CR...

  5. #15
    Location
    Santa Rosa
    Posts
    64
    Question Consult Question...ABN?
    So here's a question...
    if Medicare no longer pays for consults does that mean that we could have the patient sign an ABN and bill to the patient like we do for Medicare and physicals?

  6. #16
    Location
    North Carolina
    Posts
    3,126
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    I don't think so...

    Medicare has a crosswalk for the "former" consultation codes. If they were medically necessary in the past, they should be medically necessary now...

  7. #17
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Quote Originally Posted by dentfam View Post
    So here's a question...
    if Medicare no longer pays for consults does that mean that we could have the patient sign an ABN and bill to the patient like we do for Medicare and physicals?
    I do not think so either. If you read careful the issue is not that Medicare will not pay for these services it is that they are considering the codes for consultation as invalid codes therefore you could not bill an invalid code and then bill the patient when denied by Medicare. Consultation services are still recognized services just coded as either new or established or in the case of inpatient as initial visit.

    Debra A. Mitchell, MSPH, CPC-H

  8. #18
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    So what about follow up inpatient visit's from the cosulting ? Would you code the initial admit for the cosult and then follow up inpatient visit's after ?

  9. #19
    Location
    Columbia, MO
    Posts
    12,843
    Default
    yes and you get to bill for one initial level after that all are subsequent there will be no reconsulting the same physician for a new problem in the same admission.

    Debra A. Mitchell, MSPH, CPC-H

  10. #20
    Location
    Phoenix, AZ
    Posts
    620
    Default
    One of my MDs just came in and said that Congress is delaying the change. Can anyone confirm or deny? I've been googling and checking CMS and can't find anything. I think its just wishful thinking on his part.

    Thanks!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

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