CMS Will Offer New Modifier to Denote Admitting Physician on Claims
Posted on 22. Nov, 2009 by Editor in Provider News
Pop the champagne cork & get ready for brand new inpatient coding rules.
With the changes to consult coding in 2010, it will be more important than ever to report hospital visits properly.
In the past, only the admitting physician reported initial hospital care codes (99221- 99223), and specialists who saw the patient separately often billed inpatient consult codes. With the no-pay policy on consult codes, CMS is poised to allow specialists to bill initial hospital care for their first visit with a patient.
Modifier addition: Because multiple physicians may end up billing the initial hospital care codes during a patient’s visit, CMS will release a new modifier in 2010 that will signify which physician admits a patient to the hospital, says Melissa Briggs, CPC, with Stormont-Vail HealthCare in Topeka, Kan.
In black and white: “Because of an existing CPT coding rule and current Medicare payment policy regarding the admitting physician, we will create a modifier to identify the admitting physician of record for hospital inpatient and nursing facility admissions,” the CMS Physician Fee Schedule Final Rule indicates.
“For operational purposes, this modifier will distinguish the admitting physician of record who oversees the patient’s care from other physicians who may be furnishing specialty care.”
Each physician will be able to bill from the 99221-99223 code range only once, after which they’ll report subsequent hospital care codes (99231-99233).
Keep an eye on the Part B Insider, where we’ll update you on the information about the new modifier as soon as CMS releases it.
If you've already signed in and are still seeing this screen, click here to refresh the page.
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers
Loading ...
kathy mckay
23. Nov, 2009
I do billing for hospitilist in a hospital
will there be a lot of changes in cpt /icd
that are used for them
thank you for yoyr help
kathy
jennifer.godreau
23. Nov, 2009
There will be a few – mainly surrounding the consult issue. For instance, if the hospitalist shares a “consult” with an NPP and does not duplicate/perform the key portions, the hospitalist will still be able to use the hospital care codes, according to Medicare’s new consult guidelines. There are also new telehealth consult codes for Medicare. For resuscitation, Code 99465’s revised note indicates “99465 may be reported in conjunction with 99460, 99468, 99477.” That’s all I can think of, not too many EM ones. Jen
Renee
04. Dec, 2009
I heard that the modifier was going to be A1 to be applied to the admitting physician coding. Have you heard anything?
Geri
07. Jan, 2010
If a physicians see’s a Medicare patient for a sore throat, then see’s another physician (surgeon) for abdominal pain referred by his physician, how do you bill 2 separate E&M’s with the same tax id since consults are out?
Jennifer
07. Jan, 2010
You would bill the appropriate new or established patient office visit code for each encounter. The different specialties treating the patient should eliminate any two same day 99201-99215 edits.
Jen
07. Jan, 2010
The new modifier for the principal physician of record in a hospital now that consults will no longer be recognized by Medicare is modifier AI:
http://www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf