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consultation changes for 2010

  1. Default ER visits
    Medical Coding Books
    Does anyone know how to bill an ER visit for a Medicare patient in 2010, if the visit previously met the criteria to be billed as a consult how should it now be billed?

  2. #12
    North Carolina
    The proposed crosswalk is 99201-99215. However, there is still an open issue with 99281-99285 since the current rule allows...

    Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting

    If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill a consultation if the criteria for consultation are met. If the criteria for a consultation are not met and the patient is discharged from the Emergency Department or admitted to the hospital by another physician, the physician contacted by the Emergency Department physician should bill an emergency department visit. If the consulted physician admits the patient to the hospital and the criteria for a consultation are not met, he/she should bill an initial hospital care code.

    Since 99284 carries 2.56 RVU's and 99204 (assuming they are new) carries 2.30 RVU's, I could see physicians preferring the ER CPT codes.

  3. Wink
    Quote Originally Posted by mm3290 View Post
    The information you are looking for regarding consultation codes for 2010 is located in the final rule published in the 11/25/2009 federal register. CMS is no longer reimbursing for the consultation codes, most likely other payors will follow suite. The consultation codes are still valid CPT codes. Hope this helps!
    You can find it on page 31-39. Hope that helps.

  4. #14
    Default Consultations

    Are you all sure consultations are going away after this year. I just spoke with a representative for Medicare Trailblazer (Oklahoma, Texas, New Mexico, and Colorado). He said that nothing had been finalized at this time and that consults were still going to be valid next year as of right now. He said Medicare was primarily focused on fine tuning the fee schedule at this time and may or may not finalize their plans for consultations. I have explored the links provided by everybody, but I found his comments very interesting


  5. Default
    Several of the Medicare contractors have told me that they just have not received their finalized instructions from CMS and are still awaiting that before passing on any information regarding the consultations.
    ~Ursula, CPC~

  6. #16
    Mountain Home, AR
    Default Consults
    Medicare in Arkansas has release the fee schedules. No consults are included on the fee schedule.

  7. #17
    Same in Georgia...

  8. Default
    Highmark Medicare is having a webinar on 12/22/09 on the topic "in-hospital visits". It might be interesting to attend and ask questions.

    to register:
    ~Ursula, CPC~

  9. Default
    Quote Originally Posted by asma_wagih View Post
    You can find the final ruling in the Federal Register, November 2009. These sort of things are always posted in there.


    Good Luck!
    thanks! LOL

  10. #20
    Charlotte, NC
    How are split/shared visits going to be looked at now for Inpatient?

    We had a webinar in our office last Friday (but it took place earlier so we couldn't ask questions) that shows on one of the slides "Split/shared visits look to be allowed now". This is for MD's and mid-levels.

    Any ideas?


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