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Thread: Consultations on non-medicare patients

  1. #1

    Default Consultations on non-medicare patients

    AAPC: Back to School
    Medicare is no longer recognizing consultation codes, but nothing has been said about commercial payors. Does this mean we no longer have to have the request from the surgeon on medicare patients only. On pre-op physicals where the H&P is part of the global procedure we would still need something from the surgeon indicating a chronic conditon in order to make the visit medically necessary. Do you agree? Or do we just code a problem visit and if the patient has HTN or whatever we code as problem visit and we should be covered. Do we continue as we always have and get the request and bill consultation codes on non-medicare patients, etc. or do we have a option of not coding any consultation visits and code all payors with a problem visit. Please advise. Thanks

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Deep breath...... Some payers MAY continue to consider consultations as valid codes but it is EXPECTED that all other payers will follow Medicare. Do NOT automatically assume that a referral from the requesting physician is no longer required ... it may be. A pre op encounter was NEVER to be coded as a consultation encounter. If this is your patient and the surgeon is requesting a medical eval for surgery then it is not a consult it is just an eval. You should be using a V72.83 as the primary dx. The visit is suppose to be coded not as a consult but as the same surgery code as the surgeon is planning plus the 56 modifier. This is part of the surgical global process and if the surgeon is passing it off to you then you must bill the front (pre op) end of the global procedure as your part. This is the way the AMA designed the CPT system to work.
    Last edited by mitchellde; 12-13-2009 at 07:22 AM.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007


    I actually called several of our third-party payers and only 1 is following Medicare at this time-Excellus/BCBS. I wasn't very happy with that answer

  4. #4
    Join Date
    Apr 2007


    One more thing...do either of you know if modifier -AM will be the modifier used for the admission that was done by our own docs? I can't find much information online. Thanks for any help!!

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