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New medicare consult coding changes

  1. #11
    Question
    Exam Training Packages
    there's logic related to this in CODING EDGE Oct, 2009 here's the link:

    http://djk9qtinkh46n.cloudfront.net/...a666b0e966.pdf

    "E/M levels are all about giving the doctor credit for his/her cognitive work in evaluating the patient...if a doctor is encountering a problem for the first time, even if the patient is established within the practice, more cognitive work is required by the physician…”

    by Marvel Hammer, RN, CPC,CCS-P, PCS,ACS-PM, CHCO

    Therefore, if the doctor does a work-up on a patient new to him/her, it seems that a new encounter code can be billed?

    There's also a quote favoring similar logic by a former HCFA-CMS executive

    Of course, I'm new to this…

    JAMES

  2. #12
    Location
    Milwaukee WI
    Posts
    4,466
    Default New problem NOT new patient
    Quote Originally Posted by Jamesmmm View Post
    there's logic related to this in CODING EDGE Oct, 2009 here's the link:

    http://djk9qtinkh46n.cloudfront.net/...a666b0e966.pdf

    "E/M levels are all about giving the doctor credit for his/her cognitive work in evaluating the patient...if a doctor is encountering a problem for the first time, even if the patient is established within the practice, more cognitive work is required by the physician…”

    by Marvel Hammer, RN, CPC,CCS-P, PCS,ACS-PM, CHCO

    Therefore, if the doctor does a work-up on a patient new to him/her, it seems that a new encounter code can be billed?

    There's also a quote favoring similar logic by a former HCFA-CMS executive

    Of course, I'm new to this…

    JAMES
    I understand your confusion, James. But what this is saying is that if the problem is new to this physician, then he gets problem points for a NEW problem in determining MDM. The patient is still established; but the problem is new.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default Dr Training
    I agree that only true specialty consults should be using consult or initial care codes. I am currently doing professional services billing where the provider submits the code. Every APRN, PA, and Dr that sees a patient was using the consult codes. They only changed to the inital admit because they have to. Even with that we are now sending back submitted charges because they are up coding when submitting the Medicare initial care codes. What level of exam was it then? I can see why Medicare put their foot down and said "no more".

  4. #14
    Location
    East Stroudsburg, PA
    Posts
    78
    Angry
    So I just got off the phone with Medicare because I am now getting denials for consults codes that we billed as initials. The response I got was the patient was seen by my doctor as a consult. He is a Trauma/General surgeon. Patient was also seen on consult by a Cardio Surgeon but because they are both surgeons, only one can bill the consult as a initial visit (99221-99223) Since the other surgeon billed as the initial visit, ours got denied and I was directed to bill as a subsequent.

    I pulled out the webinar to see if this was addressed and it was not. I also looked through all my notes that I have on this mess and there is nothing that I can find to show that only one initial visit can be billed by the same type of specialist during a stay. I understand if they were both General Surgeons but they are not.

    Anyone else running into this? My director recommend that I call Medicare back tomorrow to see if I get the same answer. So Frustrating!
    ~Rebecca, CPC, COSC, CPC-I

    "To the world you may be one person, but to one person you may be the world" ~Anonymous

  5. #15
    Default Not yet....not holding my breath either
    Is it because they are in the same group? Who is your medicare carrier?

    This is concerning me, I have CVT surgeons and many times there are other surgeons also seeing the patients during the same stay. We are not in the same group though so I have no idea what it happening with their billing. So far no rejections on our end though.

    I am going to write this question down to ask in an upcoming WPS audioconference.

    Laura, CPC, CPMA, CEMC

  6. #16
    Location
    East Stroudsburg, PA
    Posts
    78
    Default
    Two different dr's and specialty and group.

    Ortho for the Radial Fracture, Neuro for the skull fracture with Subdural Hematoma.

    So Frustrating! I am attending the Medicare Webinar tomorrow and I plan to ask this question. I also pulled the MLN matters from 1/1/10 and there is nothing in there about this. Our carrier is Highmark.
    ~Rebecca, CPC, COSC, CPC-I

    "To the world you may be one person, but to one person you may be the world" ~Anonymous

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