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Subsequent vs. Initial Care Code for Initial Contact with patient

  1. #1
    Default Subsequent vs. Initial Care Code for Initial Contact with patient
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    If you read my previous post, last week National Government Services indicated that all clinicians could report an initial care code for their first encounter with a patient, as long as no one else from your practice treated the patient during that admission.

    I gave them the scenario, if a patient is admitted over the weekend and I assume care on Monday as their primary, would I bill initial or subsequent care (different practice admitted), last week they said, bill an Initial Care Code with the AI modifier---- Today that has changed.

    Now they are saying:If a patient is admitted over the weekend by another doctor from a different practice and you see the patient for the first time on Monday, you will still bill the subsequent care code and not the initial care code, even though it is your first encounter with that patient and nobody else has seen them from your practice. I think they are looking at where you "asked" to see the patient by another doctor for your opinion, so they are still applying the consultation rules, just not paying you for the consultation codes. Has anyone else gotten the same clarification on this?
    Heather Winters, CPC, CFPC

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    From what I have heard on the teleconferences thus far: The doctor that uses the AI modifier should be the physician that follows the patients care. Usually that would be the same as the admitting - but, if not (and it was not one of your doctors in your practice), then the doctor that will be their 'primary' physician during their stay would use the AI. But, both will bill an initial care (provided all of the required components are met). If all three key components are not met - then a subsequent care visit would be billed.
    ~Ursula, CPC~

  3. #3
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    Tammy, boy this stuff just keeps getting more and more confusing. I wanted to ask you a question about the CMS teleconferences, if I might. I have been hearing a lot about them lately, especially in light of the consult codes going away. Can you please tell me where I can find access to these? Are they free? I know these are probably silly questions, but I honestly don't know where to begin to find them. If they are for a fee, that is probably why as our hospital will absolutely not pay for anything coding related around here, ever! I would be very interested in them if anyone can listen in.

  4. #4
    Default Ngs
    National Government Services has free teleconferences. I believe this was the last one though. According to National Government Services, my MD as the primary care doctor would only bill a subsequent code and since my doctor did not admit the patient, the patient who was the attending at the time of the admission gets to bill the AI code. It appears they want to apply the consultation rules in the sense that, if your provider saw the patient at the request of another clinician to render his opinion, you can bill the initial care code, however, in the above scenario, if my doctor is assuming care on Monday, since he bills a subsequent care code. It is just a mess.
    Last edited by heatherwinters; 01-20-2010 at 01:02 PM.
    Heather Winters, CPC, CFPC

  5. #5
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    Wow, this sucks.

    They can't have it both ways. What am I saying, they are the government they can have it anyway they want. The question now is where is that in writing? All of the published materials clearly state consults and their rules are no more. They are now saying the first time you see a patient you get the initial codes, if you actually admited you use the modifier AI. How can they reference the rules they just threw out????

    Unreal.

    As far as CMS carrier education sessions I have done teleconferences thru both WPSMedicare and HighmarkMedicare. Check their sites out.

    I got this link from WPS on Monday

    http://www.wpsmedicare.com/part_b/ed...schedule.shtml.

    Laura, CPC, CPMA, CEMC

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    Leslie, I often attend NGS, WPS, Palmetto and Highmark teleconferences. I check their websites once a week or so - so that I can assign out these to our staff that handle claims for their jurisdictions. I usually attend them as well - and some are way more organized than the others. Highmark is phenomenal and almost always provides free CEUs for their webinars and teleconferences.

    They have another one coming up:
    https://highmark.webex.com/mw0305l/m...hmark%26%26%26

    the handouts can be found at:
    https://www.highmarkmedicareservices...uts-020210.pdf

    you may find them helpful - even if you don't attend.
    ~Ursula, CPC~

  7. #7
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    Thanks so much for all of the info ladies! I really appreciate it, although, I don't know as I will ever get a hold on these new consult "rules"

  8. #8
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    Default
    Quote Originally Posted by heatherwinters View Post
    If you read my previous post, last week National Government Services indicated that all clinicians could report an initial care code for their first encounter with a patient, as long as no one else from your practice treated the patient during that admission.

    I gave them the scenario, if a patient is admitted over the weekend and I assume care on Monday as their primary, would I bill initial or subsequent care (different practice admitted), last week they said, bill an Initial Care Code with the AI modifier---- Today that has changed.

    Now they are saying:If a patient is admitted over the weekend by another doctor from a different practice and you see the patient for the first time on Monday, you will still bill the subsequent care code and not the initial care code, even though it is your first encounter with that patient and nobody else has seen them from your practice. I think they are looking at where you "asked" to see the patient by another doctor for your opinion, so they are still applying the consultation rules, just not paying you for the consultation codes. Has anyone else gotten the same clarification on this?
    Heather - the way I understand this, is that if the admitting doctor was covering call for your doctor (same specialty - ie FP or IM?) over the weekend, and your doctor is really the patient's PCP, the admitting doctor gets the admit and your doctor does subsequent visits. I don't think that's changed just becasue of the new "no consult code" issue. But it certainly does get confusing with the language stating "all other physicians who perform an initial evaluation and management may bill the initial hospital care codes (99221-99223)". I still would not encourage my docs to code an initial visit just because the patient was admitted by another doc covering call...that just doesn't seem right to me.
    Lisa Bledsoe, CPC, CPMA

  9. #9
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    I agree with Lisa, in a covering situation nothing has changed that I am aware of.

    I didn't read this as a covering situation though.

    Laura, CPC, CPMA, CEMC

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