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Consults for 2010

  1. #1
    Default Consults for 2010
    Medical Coding Books
    I know consultation codes are being eliminated, starting January 2010.

    My question is -- What are we going to bill? I was told we are suppose to use initial inpatient -- can someone verify this? I did not see anything on the CMS website. I have seen plenty of blogs but they are just as confusing. Can someone point me in the right direction?

    Thank you so much.

    Karen

  2. #2
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    The final rule tells us that the admitting physician will bill his initial visit with an A1 modifier and then when the consultant is called in he will bill an initial visit code (regardless of whether this is day 1 or day 5) with no modifier. Thw office visit consultations will be replaced with new or estb visit levels.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Not that our opinion counts, but wouldn't it be easier to have the consultant use a modifier? Just a thought.
    Lisa Bledsoe, CPC, CPMA

  4. #4
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    I had to chuckle at this also. It would have been easier if they had asked us first!

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    Note, the modifier for the admitting physician of record is AI (a-eye), not A1. Check your HCPCS book or CMS website for the description of both modifiers. This is a common misinterpretation and I bet it causes a lot claims filing errors in January!
    Jenny Berkshire, CPC, CEMC, CGIC

  6. #6
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    I thought the same thing but it did look like a 1 in the transmissions I read and then I saw one print it out as A one so now I wonder. How confusing all of this is!

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    Here is the description of both modifiers from CMS's site ( http://www.cms.hhs.gov/HCPCSReleaseC...tNumPerPage=10)


    AI 00100 7 PRINCIPAL PHYSICIAN OF RECORD Principal physician of rec
    A1 00100 7 DRESSING FOR ONE WOUND Dressing for one wound
    Jenny Berkshire, CPC, CEMC, CGIC

  8. #8
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    Quote Originally Posted by mitchellde View Post
    The final rule tells us that the admitting physician will bill his initial visit with an A1 modifier and then when the consultant is called in he will bill an initial visit code (regardless of whether this is day 1 or day 5) with no modifier. Thw office visit consultations will be replaced with new or estb visit levels.

    So to make sure I FULLY understand -

    Dr. A -- 99223-AI
    Dr. B -- 99223 (consulting dr)?

    Is this right?

  9. #9
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    I just looked at the earlier transmittal I got and it does look so much like a 1 but clearly this is the lates on this and it is an AI. Thank you so much that really helps.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
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    Quote Originally Posted by Gemini18 View Post
    So to make sure I FULLY understand -

    Dr. A -- 99223-AI
    Dr. B -- 99223 (consulting dr)?

    Is this right?
    That is the way I read it!

    Debra A. Mitchell, MSPH, CPC-H

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