Think You Understand the New Consult Rules? Find Out Fast
Posted on 04. Mar, 2010 by Editor in Hot Coding Topics
Check your 2010 consultation coding savvy.
Find out if you’re set to properly code your physician’s consultation services this year by tackling three problems and their solutions.
Check With Your MAC for Guidance
When your physician sees a Medicare inpatient and would have used an inpatient consultation code, this year you should report an initial hospital care code (99221-99223). If the E/M service and documentation do not meet the requirements of an initial inpatient hospital care code, however, your coding will now depend on your Medicare Administrative Contractor’s (MAC) or carrier’s policy.
Problem: The lowest initial hospital care code (99221) requires a detailed history and detailed exam. When your physician’s documentation does not reach this level, there is a question as to what CPT codes you should use.
Option 1: Some MACs/carriers have stated that you should use the subsequent hospital care codes (99231-99233). “Our MAC (Highmark) has actually stated to not use 99499 (Unlisted evaluation and management service) for consultations and to use subsequent care codes,” says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network. She adds that instructions about whether or not to use 99499 seem to be MAC-by-MAC specific right now.
Option 2: Other MACs, however, have instructed practices to use the Not Otherwise Classified (NOC) code 99499, says Quinten A. Buechner, MS, MDiv, CPC, ACSFP/ GI/PEDS, PCS, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis.
For example, WPS Medicare states on its Web site: “Many providers have questioned the use of a subsequent care code when the provider does not meet the requirements of an initial care code. Wisconsin...
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Blair
15. Mar, 2010
The only other hang up with billing MSP an appropriate E/M code is that if the primary payor paid a consult code, for example, 99253 and then you bill MSP and equivelant E/M code, for example, 99221, which equates to a 99253, you most likely won’t receive any additional payment from MSP. This being because many primary payors fee schedules allow more for the consult code billed than MSP allows for the equivelant E/M code that your billing.
Barb
20. Mar, 2010
then there is the issue if you send primary and MSP electronically. If the primary pays as a regular consult MSP probably will not consider anything anyways because they will not recognize and reject the code thus submitting the 2ndry payer again to get reimbursement is much longer and time consuming if you will even get anything from MSP.