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Thread: hospital consult coding question

  1. #1
    Join Date
    Apr 2007
    Newport News, Va.

    Default hospital consult coding question

    AAPC: Back to School
    Hello everyone, Im a new coder and i'm having trouble with consultation from my patient that are seen in the hosptial. My doctor which is family practice was asked to see a patient that was admitted in the hospital as a consulation. I was told that if it was a consultaion that we are not able to bill medicare. Is that right or wrong is my question? Please help me because i don't want to bill this patient if i wasn't suppose to. Please HELP

  2. #2
    Join Date
    Apr 2007


    If your doc has hospital privledges and this is his patient. You can charge a consultation code. Remember to follow medicare NEW rules for billing consults so that it will pass the first time.

    Good luck

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    Medicare (and other carriers) no longer recognizes consultations as valid service, therefore you must assign either inititial inpatient visit codes or subsequent inpatient codes. Initial visit levels (99221-99223) are now to be use to indicate if this is your physicians initial encounter in the inpatient setting at the request of the admitting physician. You cannot bil a Medicare patient for a service not recognized by Medicare.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007
    North Carolina


    In case you need the guidance for review. Start with sections:

    30.6.10 - Consultation Services (Codes 99241 - 99255) And

    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)

    30.6.11 - Emergency Department Visits (Codes 99281 - 99288)

    F. Emergency Department Physician Requests Another Physician to See the Patient in Emergency Department or Office/Outpatient Setting

    If the emergency department physician requests that another physician evaluate a given patient, the other physician should bill an emergency department visit code. If the patient is admitted to the hospital by the second physician performing the evaluation, he or she should bill an initial hospital care code and not an emergency department visit code.


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