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Consultation Code crosswalk

  1. #1
    Smile Consultation Code crosswalk
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    As far as I can tell, Medicare has no crosswalk available for the elimination of Consultation Codes. I have noticed that some websites have a "crosswalk" - but I was wondering if anyone knows of any documentation from CMS available, as to how they should be converted to New or Established codes. CMS is frustrating in the fact that they make changes or rules on something, but don't really give concrete guidelines to follow...which unfortunately leaves too much room for interpretation. Would love to hear the take on this subject from others!! Thanks!

  2. #2
    Columbia, MO
    CMS stated that you could not crosswalk the codes and the visit level is to be based on the guidelines (95 or 97) for the type of encounter, inpatient, or office visit new or established. ER visits when you are requested to see a patient in the ER are to be coded using the ER visit levels. You are not converting the the visit levels, as consultation services do not exist for medicare (and carriers following CMS policy), you are assigning the appropriate level for the type of service rendered.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Central Indiana
    We have been auditing all of our new patient visits in the office and hospital to avoid problems. The doctors don't know what the insurance is when they see a patient. Furthermore, some doctors assign codes that might not meet the particular 95 or 97 guidelines they are aiming for.

    Debra is correct, there is no crosswalk. We create 2 piles; we have a "Medicare" pile and a "not Medicare" pile. The first thing to consider when determining the code set you should be in is the Place of Service. If the documentation doesn't support anything in that category, you drop to the next one.

    One example I see frequently is with Initial Inpatient (99221-99223). These are used for hospital "consults" on Medicare patients now. My doctor will have an EPF History, Comp Exam, and Mod MDM. Since all 3 key components must be met and the history falls short, I have to use a Subsequent Hospital code where only 2 of 3 components have to meet. What should be 99222 becomes 99232 in this case.

    I have been auditing these for about 6 months now. Making sure that the doctors provide enough information for the history component is consistently the catching point. CMS is sure to be on top of these soon. I advise E/M University for physicians and coders.

  4. #4
    North Carolina
    If you haven't already, read the information provided in the Medicare Manual Chpt 12; section 30.6.10.

    30.6.10 - Consultation Services (Codes 99241 - 99255)
    (Rev. 1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)
    Rebecca CPC, CPMA, CEMC

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