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Thread: Inpatient Consultations - I am working in an outpatient setting

  1. #1

    Default Inpatient Consultations - I am working in an outpatient setting

    AAPC: Back to School
    I am working in an outpatient setting and am not as familiar with Medicare rules in the inpatient setting. Under the new consulation quidelines, patients who have medicare cannot be assigned a consultation code,..In an inpatient setting, if the patient has medicare, does the same rule apply?


  2. #2

    Default Medicare and consults

    Medicare no longer excepts consult codes in any setting, outpt. or inpt. as of 1/1/10.

  3. #3
    Join Date
    Apr 2007
    North Carolina


    These two links should provide an answer to any other questions that come to mind...



  4. #4
    Join Date
    Apr 2007
    Vancouver, WA

    Default Multiple consults on INPT Medicare pt

    Thank you for your information but I have a question. An INPT Medicare pt is seen by 2 or more specialties as consults-do you bill additional 99221-99223 codes?
    I know that the ADMIT provider bills 99221-99223 with AI modifier, then the first Consultant provider bills 99221-99223 without the modifier but what about others that may see pt as a Consult (from different speicialties of course) ??
    Last edited by carps14; 05-18-2011 at 03:15 PM. Reason: adding title

  5. #5


    Yes, the other providers will use the initial hospital care codes for their first visit.

    30.6.10 - Consultation Services (Codes 99241 - 99255)
    (Rev. 1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)
    A. Consultation Services versus Other Evaluation and Management (E/M) Visits
    Effective January 1, 2010, the consultation codes are no longer recognized for Medicare part B payment. Physicians shall code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306). The principal physician of record is identified in Medicare as the physician who oversees the patient’s care from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI”, Principal Physician of Record, in addition to the E/M code. Follow-up visits in the facility setting shall be billed as subsequent hospital care visits and subsequent nursing facility care visits.).

  6. #6


    I know that with codes 99251-99255 the rule is that "only ONE consultation should be reported by a consultant per admission".
    My question is does this rule apply to the Initial Hospital Care codes (99221-99223). I work in a specialty office and this just came up. The patient is inpatient and has been for almost 2 months; one of my docs saw the patient for an initial consult & billed the 99223....now almost 6 weeks later another of my docs want to bill another 99223 with a different diagnosis. ??
    If this is or isn't correct...where can I find this specific rule (for these codes)?

    Thanks for your help

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