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Consults Again

  1. #1
    Default Consults Again
    Medical Coding Books
    Patient is admitted by Dr.A, provider then bills an initial level visit "99221 - 99223" would now have to put modifier AI on since Dr A is admitting physician? What if they performed a low level consult (99251/99252 as in 2009)? then what do they bill?

    During the patients stay they are visited by:
    Dr.B (Endo)
    Dr.C (Gastro)
    Dr.D (Rheumatology)

    All above are consultations, since Medicare is not taking consults how will they then be billed? As straight follow-up visits (99231 - 99233)? Need to confirm.

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Dr. A admit code and mod -AI. My opinion for the consulting docs 99221 IF time is documented to meet 99251-99252. Otherwise, they would have to code a subsequent hospital code.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    Kansas City, MO
    Posts
    431
    Default
    consults- inpatient, for Medicare, use 99221-99223 for INITIAL visit, than 99231-99233 for f/u care if applicable.

    OUTPATIENT hospital or office visits, for medicare, use 99201-99205 or 99211-99215 depending in if they are new or not.

    Partha, check out http://emuniversity.com/consultinfo.htmlThis Dr, has a good article that sums up what to do.

  4. #4
    Location
    Kansas City, MO
    Posts
    751
    Default
    Partha - I'm not sure what Medicare Carrier area you are in, but I highly recommend that you check with your carrier to see what the documentation and coding guidelines are. We are in the WPS J5 MAC and they are holding teleconferences to educate providers. They are stressing the documentation element.

    When the Medicare patient is an Inpatient, the Attending Physician is to bill the Initial Admit (99221-99223) with the "AI" and then each physician that is requested to provide a consult must bill and Initial Admit (99221-99223) as well. WPS says if the documentation does not support at least a 99221, it would be incorrect to bill a subsequent visit. We must report 99499 with a note that documentation is available for review, then they will send a request for records. So, for us education with our providers will be key. We have to stress that the minimum documentation must be at least enough to bill a 99221 or they will have to document time appropriately or we are stuck billing the unlisted code.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  5. #5
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    You definitely need to check with your carrier. As Angela says, WPS is telling us to use 99499 if a level 1 initial code is not met (WPS is also MN and IA); however, Noridian, our SD MAC, has told us to use subsequent hospital visit codes. Lucky us - since we are right on the border of IA, MN and SD, we have to keep up with all of them!

  6. #6
    Default AI modifier
    What if a medicare patient is admitted and no consults are performed during their stay, would you still attach AI to 99221-99223 ? We bill for physician's at a hospital and sometimes don't know wheather or not a physcian from another hospital is called for a consult. I thought you attach AI to all medicare patients who are admitted. Can someone please clarify this. Thanks

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default AI identifies physician of record
    The AI modifier is to be added to the Initial Hospital Visit to identify the physician of record for that hospitalization.

    Use it every time your physician admits a patient, when your physician will be following that patient. (If he's just taking call over the weekend and the PCP will pick up patient care on Monday, do not use the AI. -- at least that's how I understand it.)

    F Tessa Bartels, CPC, CEMC

  8. #8
    Default
    I am being told by my co-worker's to only attach -AI if there is a consult billed the same day, i disagree because what if a physician from another hospital is called in for a consult, I have no way of knowing this so therefore i think it would be appropriate to attach -AI to all medicare admit code's. I have read these articles over and over but can't find anything stating to add it to all admit codes regardless if a consult was performed or not. Does anyone know if attaching -AI will make reimbursement different to without it ??

  9. Default CMS guideline
    The cms guidelines that the Judicational carrier are to follow states that initial codes MAY be use-- not must be use. Carriers have to impletement CMS guidelines not change them. If the dcoumentation does not meet 99221 use 9923.. and if denied appeal with CMS memorande outlining the MAY

  10. #10
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by cpccoder2008 View Post
    I am being told by my co-worker's to only attach -AI if there is a consult billed the same day, i disagree because what if a physician from another hospital is called in for a consult, I have no way of knowing this so therefore i think it would be appropriate to attach -AI to all medicare admit code's. I have read these articles over and over but can't find anything stating to add it to all admit codes regardless if a consult was performed or not. Does anyone know if attaching -AI will make reimbursement different to without it ??
    We have been told both by Noridian and WPS to always submit the AI modifier for the actual admitting physician and that it will not make any difference in the reimbursement.

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