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ER & Inpatient Consultations - Medicare

  1. Default ER & Inpatient Consultations - Medicare
    Medical Coding Books
    Since Medicare does not pay for consultations - Can the physician bill "Admits/Initial Encounter" E&M codes 99221-99223? The guidlelines state that the physician must be the admitting physician. Our Medicare A/R rep is stating that a specialist such as cardiology or orthopedics can use these codes even when not the admitting physician. Looking for guidance.

  2. #2
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    Quote Originally Posted by vhutten2010 View Post
    Since Medicare does not pay for consultations - Can the physician bill "Admits/Initial Encounter" E&M codes 99221-99223? The guidlelines state that the physician must be the admitting physician. Our Medicare A/R rep is stating that a specialist such as cardiology or orthopedics can use these codes even when not the admitting physician. Looking for guidance.
    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).

    https://www.cms.gov/manuals/downloads/clm104c12.pdf

    30.6.10

  3. #3
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    when a provider is called into the inpatient setting as a consult, for Medicare and all carriers following Medicare policy for consults, you do use the initial inpatient codes 99221-99223. These are not strictly admit codes they are admit/initial encounter codes. Meaning this is your initial encounter with the patient in the inpatient setting at the request of the admitting provider.

    Debra A. Mitchell, MSPH, CPC-H

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