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Hospital Consults

  1. Default Hospital Consults
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    I work for an orthopedic surgeon in AZ. Our claims our getting denied using codes 99221-99223. Should we be using 99231-99233?? Please help

  2. #2
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    What type of insurance does the patient's have?

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    Quote Originally Posted by tpenrose View Post
    I work for an orthopedic surgeon in AZ. Our claims our getting denied using codes 99221-99223. Should we be using 99231-99233?? Please help
    For Hospital consults you should be using codes 99241-99255. Unless the patient has medicare then you need to be using 99221-99223 with the AI modifier. But only if the patient has Medicare.
    If patient does not have medicare then the 99221-99233 codes are for hospital admissions and subsequent hospital care only, not consults.

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    Medicare

  5. #5
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    Quote Originally Posted by Bella Cullen View Post
    For Hospital consults you should be using codes 99241-99255. Unless the patient has medicare then you need to be using 99221-99223 with the AI modifier. But only if the patient has Medicare.
    If patient does not have medicare then the 99221-99233 codes are for hospital admissions and subsequent hospital care only, not consults.
    For Medicare patients, inpatient hospital consults, use 99221-99223 (without AI). The AI is added to these initial visit codes only if the doctor is the admitting provider. If he is consulting, do not use the AI modifier.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  6. #6
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    Does the documentation support 99221-99223? If not that is probably why you are coding in the 9923 series. You may have to use the unlisted code if they are not accepting 9923_.

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    Quote Originally Posted by tpenrose View Post
    I work for an orthopedic surgeon in AZ. Our claims our getting denied using codes 99221-99223. Should we be using 99231-99233?? Please help
    Unless your physician is the Admitting Doctor, you should not be using 99221-99223. The notes preceding the codes give very specific instructions on the use of these codes as they are for use by the admitting physician ONLY. If you doctor is consulting, then you would be using either 99251-99255 or the subsequent care codes 99231-99233.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  8. #8
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    Quote Originally Posted by ajs View Post
    Unless your physician is the Admitting Doctor, you should not be using 99221-99223. The notes preceding the codes give very specific instructions on the use of these codes as they are for use by the admitting physician ONLY. If you doctor is consulting, then you would be using either 99251-99255 or the subsequent care codes 99231-99233.
    Just a clarification, the original user stated that this is for Medicare, which does not allow 99251-99255 codes, have to use 99221-99223 instead, without the AI modifier, for a consult.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  9. #9
    Location
    Columbia, MO
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    Yes for Medicare and all carriers that are following Medicare you may not use consult codes of any flavor. But the AI modifier is for the admitting provider to append. The original poster is being denied the 99221-99223 codes for their inpatient consults and the answer to that is more than likely and highly probable the admitting provider did NOT append the AI modifier to their initial level so when you bill your consult with an initial level it will deny. The only course now open to you is to appeal to get paid for the initial level of care showing that you were requested to see the patient at their behest.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
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    Quote Originally Posted by mhstrauss View Post
    Just a clarification, the original user stated that this is for Medicare, which does not allow 99251-99255 codes, have to use 99221-99223 instead, without the AI modifier, for a consult.
    Thank you for the clarification. I was aware of the medicare rule on office consultations, but was not aware it extended to the inpatient consults as well. The orginal author should contact her Local Medicare carrier to find out why they are denying the code as it appears it should be covered.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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