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Thread: Please help me asap!!

  1. #1
    Join Date
    Apr 2007

    Exclamation Please help me asap!!

    AAPC: Back to School
    I code for a cardiology practice. If a consult is done by one of my docs and he consults OUR EP doc to come in next day and do consult what do I bill? I know consults for medicare are now initial codes but I am being told to bill a subsequent for EP consult. Is this not fraudulent billing or is it correct to do this? My opinion is to bill a subsequent just to get claim paid is wrong but we all know medicare will not pay 99222 more than once an admission. Also, medicare does not recognize EP as a seperate specialty so the EP doc is considered one of the same as far as specialty goes. Thanks!!

  2. #2


    99221, 99222 and 99223 can only be used by the doctor that admits the patient into the hospital. If the patient has Medicare or a form of Medicare you can't use the consultation codes any longer for them. The CPT states that if your doc did not admit the patient to use the subsequent hospital visit codes. So if your patient has Medicare or a form of Medicare, you will need to use the subsequent hospital visit code set. Make sure to add a -25 modifer since they are being seen by more than one doc on the same date.

  3. #3
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    Gcoder, the 99221-99223 can now be used in lieu of the consult codes for Medicare patients, and are not restricted to only admissions. The -AI modifier will identify the attending of record.

    For reporting a second consult by a sub specialist you would report a subsequent visit code, unless the subspecialist has a taxonomy code different from the first consulting specialist.

    Medicare will now pay when 99221-99223 is reported more than once per admission, due to the new CMS guidelines having to do with consultations.
    I would encourage everyone who is having difficulty with the ins and outs of this consultation change to carefully read MedLearn Matters article # 6740.
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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