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Changing consult codes to visits

  1. #1
    Default Changing consult codes to visits
    Exam Training Packages
    Is there anything inappropriate with allowing the physician to continue to code a consult for a Medicare patient, and then have the coder change it based on the crosswalk code (and of course taking into consideration new vs established)?

  2. #2
    Default
    I see nothing inappropriate with that but it does open you up to the possibility of errors and delays in payments due to the wrong code slipping thru.

    I know they have to remember a lot but the providers may as well get used to the consults going away and be aware of what they are doing/coding. Several of the private carriers we have contacted plan to eliminate payment for consults within the next 6 to 12 months.

    Just my opinion,

    Laura, CPC, CEMC

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Laura - do you know which private payers are moving in that direction?
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Default Consult codes
    What are the replacement codes for consults going to be? I am trying to find something in writing.

  5. #5
    Default
    I'm in Michigan but so far we have been told by all of our BC/BS they will continue paying consults until July 1, 2010 then they will update their fee schedule and follow Medicare policy.

    HealthPlus has not made a final determination yet.

    BCN (blue care network) has not made a decision yet except to say any medicare advantage plan will "most likely follow medicare guidelines".

    Michigan medicaid told me they have nothing official yet but anticipate getting something soon stating they will be following medicare guidelines as well.

    These are the biggest payors in my area so we are keeping a close watch on everything they are putting out.

    Laura, CPC, CEMC

  6. #6
    Location
    Jacksonville, Florida - 90417
    Posts
    187
    Default Consult Changes
    CMS just published a transmittal which should provide more definitive info on the consult changes. Refer to transmittal R1875CP dated 12/14/09. Change request number is 6740 (in case you happen to search by that number instead).

    Go to the following link:

    http://www.cms.hhs.gov/Transmittals/2009Trans/list.asp

    then look for Transmittal number R1875CP.
    Maryann

    Maryann C. Palmeter, CPC, CENTC, CPCO

  7. #7
    Smile Consult changes
    Thanks for the information links!!

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    courtesy ofMargie Vaught, she posted this elsewhere today as well:

    The transmittal relating to the changes of the CMS sections regarding consultations is now out... below is just a small cut and paste

    Check it out: http://www.cms.hhs.gov/transmittals/...ds/R1875CP.pdf

    "F. Initial Hospital Care Service History and Physical That Is Less Than Comprehensive
    When a physician performs a visit that meets the definition of a Level 5 office visit several days prior to an admission and on the day of admission performs less than a comprehensive history and physical, he or she should report the office visit that reflects the services furnished and also report the lowest level initial hospital care code (i.e., code 99221) for the initial hospital admission. Contractors pay the office visit as billed and the Level 1 initial hospital care code.
    All physicians who provide an initial visit to a patient during hospital care shall report an initial hospital care code (99221-99223). The principal physician of record shall append modifier “-AI”, Principal Physician of Record, to the claim with the initial hospital care code. This modifier will identify the physician who oversees the patient's care from all other physicians who may be furnishing specialty care.

    G. Initial Hospital Care Visits by Two Different M.D.s or D.O.s When They Are Involved in Same Admission
    In the inpatient hospital setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306). Contractors consider only one M.D. or D.O. to be the principal physician of record (sometimes referred to as the admitting physician.) The principal physician of record is identified in Medicare as the physician who oversees the patient's care from other physicians who may be furnishing specialty care. Only the principal physician of record shall append modifier “-AI”, Principal Physician of Record, in addition to
    the E/M code. Follow-up visits in the facility setting shall be billed as subsequent hospital care visits and subsequent nursing facility care visits.
    30.6.10 - Consultation Services (Codes 99241 - 99255)
    (Rev.1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)
    A. Consultation Services versus Other Evaluation and Management (E/M) Visits
    Effective January 1, 2010, the consultation codes are no longer recognized for Medicare part B payment. Physicians shall code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306). The principal physician of record is identified in Medicare as the physician who oversees the patient's care from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI”, Principal Physician of Record, in addition to the E/M code. Follow-up visits in the facility setting shall be billed as subsequent hospital care visits and subsequent nursing facility care visits. ). In the CAH setting, those CAHs that use method II shall bill the appropriate new or established visit code for those physician and non-physician practitioners who have reassigned their billing rights, depending on the relationship status between the physician and patient.
    In the office or other outpatient setting where an evaluation is performed, physicians and qualified nonphysician practitioners shall use the CPT codes (99201 – 99215) depending on the complexity of the visit and whether the patient is a new or established patient to that physician. All physicians and qualified nonphysician practitioners shall follow the E/M documentation guidelines for all E/M services. These rules are applicable for Medicare secondary payer claims as well as for claims in which Medicare is the primary payer.

    If the ED physician, based on the advice of the patient's personal physician who came to the emergency department to see the patient, sends the patient home, then the ED physician should bill the appropriate level of emergency department service. The patient's personal physician should also bill the level of emergency department code that describes the service he or she provided in the emergency department. If the patient's personal physician does not come to the hospital to see the patient, but only advises the emergency department physician by telephone, then the patient's personal physician may not bill.

    If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code."
    Mary, CPC, CANPC, COSC

  9. #9
    Default Diagnosis
    Does anyone think that Medicare will reject two inpatient admit claims from different physicians with the same diagnosis?

  10. Default Fee for Nursing Home Codes
    I need help with adding nursing home codes to my fee schedule and where is a good place to find out what my area is biling for? Any ideas!

    thank you

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