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Medicare coding for Consult codes

  1. #1
    Default Medicare coding for Consult codes
    Medical Coding Books
    I have been using for inpatient consult codes (99221-99223) for our patients. Is anyone doing anything different for inpatient vs outpatient consults. Thanks for your help.

  2. #2
    Columbia, MO
    The levels you are using are not consult codes they are initial inpatient visit levels and they are the accepted way to bill Medicare (and all payers following Medicar'es 2010 policy on consultations) for requests from admitting physicians to see their patients inpatient. I am very careful to not use the word consult as Medicare does not consider a consult to be a valid service as of Jan 1 2010. For your office and outpatient "consults" you will use regular new or established ov codes.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Debra, thanks for all your help in this matter. So for a new medicare patient that you see at the hospital you would use a (99203 with a 21 place of service for inpatient and new patient, correct?

  4. Default
    99203 is an office or other outpatient code.

  5. #5
    North Carolina
    Inpatient is not defined by new or established. The provider reports 99221-99223 for the initial, inpatient, visit with POS 21. If they are the admitting MD, they would report 99221-99223 with the AI modifier.

    If your provider sees the patient in the ER and DOES NOT admit the patient, you would report 99281-99285.

    Per CMS:

    "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."

  6. #6
    Columbia, MO
    Rebecca is correct, the level type depends on the patient type, just forget the consult codes for Medicare. For inpatient as I stated if theis is your initial encounter with the patient at the request of another physician then you use the 99221-99223 with POS 21 if you are just seeing your patient while they are inpatient then you use 99231-99233 with POS 21. As Rebecca states if you are seeing a patient in the ER at the request of the ER physician you bill 99281-99285 with POS 23. If you admit the patient you bill 99221-99223 with an AI modifer with POS 21. If you see them in your office either as a walk in or at the request of another physician you use 99201-99205 or 99211-99215 with POS 11.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Also-your documentation must support 99221-99223. If documentation does not support these codes we have been told to use 99231-99233 based on documentation.

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