Page 1 of 2 12 LastLast
Results 1 to 10 of 11

Thread: Medicare Crosswalk Consult Codes

  1. #1
    Join Date
    Apr 2007
    Location
    Charm City - Baltimore
    Posts
    103

    Default Medicare Crosswalk Consult Codes

    Hi - We are having a discussion on the crosswalk codes that Medicare Part B News provided, dated December 9,2009.

    If we used to bill 99243 we are now being instructed to bill either 99203 or 99213.

    But in a followup case I don't think 99213 is adequate to 99243. Assuming the same documentation is available for a correct code of 99243, I think that a 99214 would be more comparable.

    Does this sound correct?
    Crystal, CPC, CCS-P

  2. #2
    Join Date
    Apr 2007
    Posts
    1,716

    Default

    You are correct, 99243 would not crosswalk to 99213, it crosswalks to 99214 unless it is based on time and in that case would crosswalk to 99215.

    Anytime you see a crosswalk it is best to double check it based on CPT definition of the codes. When you are taking codes that are 3 of 3 down to codes that are 2 of 3 you have to be careful. And as I mentioned check your times. They are different for each code set. On the inpatient side the times for 99221-99223 are 30 min 50 min and 70 min a 99254 is 80 min. So if you are coding based on time 99254 goes to 99223 but if you are coding based on key components it goes to 99222.

    Hope this is helpful,

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Location
    Greeley, Colorado
    Posts
    2,046

    Default

    I agree with Laura. That is what I am telling my docs.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Join Date
    Apr 2007
    Location
    Charm City - Baltimore
    Posts
    103

    Default

    Thanks for your help!
    Crystal, CPC, CCS-P

  5. #5
    Join Date
    Apr 2007
    Location
    Biloxi, MS
    Posts
    177

    Default

    Coding E&M university sent me a seven min video on consult revenue changes here is the link http://emuniversity.com/TLC/player.html

  6. #6
    Join Date
    Apr 2007
    Location
    Minneapolis
    Posts
    199

    Default

    Do you have a link to the Medicare Crosswalk?
    Missy Heuer CPC, CANPC

  7. #7
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,902

    Default

    I am not sure why there is a need for a crosswalk of any kind. The transmittal CMS put out has instructed that the guidelines for the required levels be followed so if the documentation is equivalent to a level 4 then it is a 5 then it is. You must follow the stated parameters for either a new patient or established patient or initial inpatient. Forget about what level it would be as a consult and look at what level it is for the type of patient it is just as though it were not a consult.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Join Date
    Apr 2007
    Location
    Waterbury
    Posts
    3

    Default Crosswalk

    Part B New is written by Decision Health not by Medicare. Per Medicare there is no Crosswalk. I agree with this but I am being told by my manager and supervisor to just use these codes. I am not sure if the Doctors are aware that we are doing this. Isn't this illegal? Are my CPC credentials on the line if I do this without the documentation in front of me or the Dr's permission? Would something in writing from my manager cover me in this situation?

    Very worried and don't look good in orange.

  9. #9
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,902

    Default

    You must have the documenttion to code a visit level there is no crosswalk these are very different levels of service and the only way to assign one is by using the 95/97 guidelines with the documentation. If this is not provided then you have a choice to submit the consult code selected and know it will be denied or submit no E&M at all.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10

    Default CMS Crosswalk of Consultantions

    http://lib.store.yahoo.net/lib/pmico...SULT-CODES.PDF

    Link I found from AMA 2010 for the coding crosswalk if Patient is Medicare. Hope this helps.

    Amy Wright, CCP-AS, CCP-H, CCP, CPC-H, CPC, CBMS
    KentuckyOne Healthcare
    Kraft Healthcare Consultants
    Amy Wright,
    ICD-10-CM Proficient, CCP-AS,CPC-H CCP-H CPC CCP CMBS
    Coder Educator/Auditor Consultant
    859-402-5117

Page 1 of 2 12 LastLast

Similar Threads

  1. Reimbursement for consult codes vs medicare new office/hospital eval codes
    By cardiocoder in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-20-2014, 08:09 PM
  2. medicare and consult codes
    By mmorneau in forum Compliance General Discussion
    Replies: 3
    Last Post: 12-22-2010, 08:56 AM
  3. Medicare coding for Consult codes
    By ozarkortho in forum Orthopaedics
    Replies: 6
    Last Post: 07-21-2010, 11:13 AM
  4. Medicare secondary consult codes
    By kbreeden in forum E/M
    Replies: 14
    Last Post: 01-08-2010, 07:18 AM
  5. Medicare Elimination of Consult Codes
    By cbrister in forum Medicare Regulations
    Replies: 11
    Last Post: 10-02-2009, 10:28 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.