Ask 3 Questions to Head Off 2010 Consult Problems Before They Start
Posted on 17. Dec, 2009 by Editor in Hot Coding Topics
Ever used an unlisted E/M code? Get ready.
By now, you’ve heard that CMS is doing away with all inpatient (99251-99255) and outpatient (99241- 99245) consultation codes in 2010 — but are you prepared for the issues this may cause, starting Jan. 1? Ask these three questions of your practice and payers, and you’ll fend off headaches before they start.
Keep in mind: While Medicare has released the transmittal letter to all carriers instructing them about the policy change to no longer payer for consultations, Senator Arlen Specter (D-PA) introduced an amendment to the Patient Protection and Affordable Care Act (H.R. 3590) to delay this policy change by one year. This amendment was added on Dec. 14, 2009. If Congress does not pass this bill before the end of the year, the Medicare policy will go in as planned. Check the Ob-gyn Coding Alert and SuperCoder for more developments, but be prepared just in case.
Ask 3 Questions to Head Off 2010 Consult Problems from Erin masercola on Vimeo.
1. Do Medicaid and Private Payers Have Consult Advice?
If a physician sends a Medicare patient to your ob-gyn for a consultation, you should use regular E/M codes (99201-99215, Office of other outpatient visit for a new or established patient …) instead. But what about the other insurers?
“We have to remember that right now, this is just Medicare,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis., who led the “Consultations” session at the 2009 Ob-Gyn Coding & Reimbursement Conference in Orlando.
Medicaid and private payers may follow suit — or they may not have even learned of CMS’s decision. “Four weeks ago, I asked a secondary insurance company what they were doing...
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Paul L DIckson, MD, CCS, CPC
18. Dec, 2009
“Translation: An emergency room (ER) doctor admits a patient who was involved in a motor vehicle accident and calls in the ob-gyn to perform a consult for vaginal or uterine bleeding. The ER doctor would report 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient …) with modifier AI appended. The ob-gyn then bills 99221-99223 with no modifier.”
Need to use a better example, how many times do you see an ER Doctor admit a patient to inpatient status and bill the Initial H & P (99221-3) for his services.
Overall, I agree that there is going to be a great amount of confusion and anger once the docs start receiving denials because they are not usually pro-active in their coding and billing activities and unfortunately, it is necessary as it is their business!
PaulD
Cynthia
18. Dec, 2009
I am confused with the changes to consultation codes. How would I code preop? I usually use 99241 – 99245 codes. Now that medicare is no longer accepting these codes. How will I bill for these codes?
Ashley L.
20. Dec, 2009
Our FI told us specifically not to use the unlisted codes. Instead we will crosswalk the IP consults to sub-day (daily care) codes. Is anyone else doing this?
Suzanne Leder
22. Dec, 2009
Hi Dr. Dickson,
I agree the example was problematic, hence it being changed! Thanks for bringing this to our attention.
Suzanne
Executive Editor, The Coding Institute
H Winters, CPC
06. Jan, 2010
It is my understanding today after listening to a Medicare teleconference and the subsequent Q&A session sponsored by NGS, things may not be all cut and dry.
They directed that If a patient sees a doctor in the ER for a consultation, that consultation would be billed using ER codes like the ER physician uses. Emergency Department (ED) Codes 99281 – 99285 were selected based on where visit occurred and complexity of visit performed.
Concerning the modifier AI, it may not be correct to have the Admitting MD use it in all scenarios. They indicated that it’s purpose is to identify the doctor who will be responsible primarily for the patient’s care while they are in the hospital. A doctor asked, what if a patient is admitted by someone other than their regular MD on a weekend, and the patient’s regular MD is expected to follow up with the patient and assume care on Monday, In this scenario, do we still have the admitting MD use the AI modifier? The presenter did not feel that the AI modifier should be used by the admitting MD because he is not expected to be responsible for the patient’s care throughout the hospital stay. When this response was give, they were further questioned – When the primary MD returns on Monday and assumes the care of the patient, would he be able to bill an initial care code with the AI modifier sine the admitting could not. To this they responded at first no, a subsequent care code, then indicated they would need to check into this further and to check back on the QA section later. I think they are still working out the kinks in this system and how they want their new rules interpreted and who should use the AI informational modifier. Applying it to all admitting MD’s may not be correct. I’d check back for clarification on this.
There seems to be no easy crosswalk or rule of thumb yet. For 99251 and 99252 – since there is no initial care code with a Problem Focused or Exp. Problem Focused History and Exam, you are directed to choose from the 99231–232 codes instead of the lowest level 99221.
For Outpatient Pre-Op clearance – it was indicated that if we bill using the 99201-99215 e/m codes instead of the consult codes and continue to assign the appropriate Icd-9 and V code assignment and sequencing rules we did previously.
For more information and the Q&A you can go to National Government Services Website. Please review it to confirm my understanding of what was presented. They have a calendar of events that lists two more free audio conferences coming up concerning this topic.
Right now the whole thing seems as clear as mud. They are trying to delete a set of codes without redefining those that are left. I look forward to further clarification and discussion on this topic