AAPC - Back to school
Results 1 to 4 of 4

Thread: Consultation Code crosswalk

  1. #1
    Join Date
    Apr 2007

    Smile Consultation Code crosswalk

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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. www.emuniversity.com

  4. #4
    Join Date
    Apr 2007
    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)


Similar Threads

  1. Asa crosswalk code for 64635
    By jebapriyaben in forum Anesthesia
    Replies: 4
    Last Post: 07-18-2013, 06:17 AM
  2. HCPCS Level II code Crosswalk
    By bill2doc in forum Urology
    Replies: 0
    Last Post: 04-28-2013, 09:53 AM
  3. Crosswalk for consultation codes
    By perkins05 in forum E/M
    Replies: 1
    Last Post: 02-24-2012, 11:53 AM
  4. REV Code/CPT Crosswalk
    By mclemons in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-06-2011, 10:55 AM
  5. NDC# crosswalk to Flu Vaccine code
    By kellyq0416 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-03-2010, 02:20 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.