Results 1 to 5 of 5

Hospital Consult Medicare

  1. Red face Hospital Consult Medicare
    Exam Training Packages
    Can someone please refresh me on what code to bill Medicare for an initial hospital consultation, which resulted in surgery. I'm sure I will need to modify the CPT with a
    "57", but want to make sure I'm billing the consult correctly.

    Thank you,

    CW

  2. #2
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    Actually Medicare would like you to bill the Intial inpatient day codes 9922X. There is no modifier you need to add. Choose your level based on the documentation. Here is a link from CMS on this.

    https://www.cms.gov/MLNMattersArticl...ads/mm4215.pdf

  3. Red face Hospital consults
    You made my day easier.

    Thank you

    Cw

  4. Default
    Per CPT, it has appeared to me (and perhaps I am wrong) that only the admitting physician uses 99221-99223. All other physicians (including consultants) use 99231-99233. If surgery is done, the "57" modifier would be added. Anymore thoughts?

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by madgejones10 View Post
    Per CPT, it has appeared to me (and perhaps I am wrong) that only the admitting physician uses 99221-99223. All other physicians (including consultants) use 99231-99233. If surgery is done, the "57" modifier would be added. Anymore thoughts?
    Medicare has a different policy. If it's a commerical plan that doesn't follow Medicare, the consultation codes are still applicable. The consultation codes are still valid in CPT.

    30.6.10 - Consultation Services (Codes 99241 - 99255)

    (Rev. 1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)

    A. Consultation Services versus Other Evaluation and Management (E/M) Visits
    Effective January 1, 2010, the consultation codes are no longer recognized for Medicare part B payment. Physicians shall code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. 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).
    The principal physician of record is identified in Medicare as the physician who oversees the patient’s care from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI”, Principal Physician of Record, in addition to the E/M code. Follow-up visits in the facility setting shall be billed as subsequent hospital care visits and subsequent nursing facility care visits. ).

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

Similar Threads

  1. Replies: 3
    Last Post: 07-09-2015, 07:40 AM
  2. Reimbursement for consult codes vs medicare new office/hospital eval codes
    By cardiocoder in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-20-2014, 09:09 PM
  3. Billing OV Consult vs Hospital Consult
    By crowemd in forum Auditing General Discussion
    Replies: 1
    Last Post: 02-20-2012, 03:02 PM
  4. hospital consult or subsequent hospital care?
    By cruiser1472001 in forum E/M
    Replies: 2
    Last Post: 01-26-2010, 12:39 PM
  5. Replies: 1
    Last Post: 01-24-2008, 02:16 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?

Login

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.