AMA Symposium Report: Low-Level Consult Reporting in 2010

Posted on 18. Nov, 2009 by jennifer.godreau.

Hey, Coding News readers! It’s your turn to weigh in on the consult controversy.

Question: What should you do for Medicare 2010 coding if an inpatient consult on a patient’s initial hospital day does not support 99221?

Answer: Kenneth Simon, MD, MBA, FACS, CMS, senior medical officer at the CPT symposium was very adamant that you would have to use 99221. When questioners kept asking “But how could you use 99221 if the documentation didn’t support that level?” he continued to say, “On day 1, use 99221-99223.” His blunt repetition angered many attendees.

Ken, however, based his idea on data that Medicare used for the consult elimination that indicated most consult are coded as high-level consult. Therefore, he seemed to think the low levels would not be problematic.

How many of you currently are using low level consults (99251, 99252)? Let us know in a reply to this question.

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Medicare’s Consult Rule Trickle Down Effect

Posted on 18. Nov, 2009 by jennifer.godreau.

And what it means for pediatric practices. A report from AMA in Chicago.

Although CPT clarifies the transfer of care definition, the fix came too late for Medicare, meaning your private payers may follow suit.

Continued Errors Result in E/M Boon

The Office of Inspector General found a high error rate on consultation codes. Different opinions on when a transfer of care occurs versus a consultation caused $1.1 billion in incorrect payments. “We couldn’t even all agree on some scenarios,” admitted William J. Mangold, Jr., MD, JD, Noridian Administrative Services’ (Arizona, Montana, Utah, Wyoming) Medicare contractor medical director in the carrier response section to Day 2′s opening session at the CPT and RBRVS 2010 Annual Symposium in Chicago.

Pediatricians who don’t regularly code consults could gain from Medicare getting fed up with the inconsistency and invalidating the codes for payment in 2010. CPT still maintains the codes. CMS, however, will take the payments for 99241-99255 (Consultations) and redistribute them to office visits (99201-99215), hospital care (99221-99233), and nursing home (99304-99310) codes. This will create a 6 percent boost for primary care in E/M reimbursement from private payers that adopt the 2010 Medicare Physician Fee Schedule.

Get ready for ‘Dante’s Inferno,’ says one veteran coder.

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CMS at AMA Chicago: We’re Reducing Consult Request Requirement

Posted on 13. Nov, 2009 by jennifer.godreau.

CMS auditors will look for 1 less thing in consult documentation.

With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.

Separate ICD-9 codes will help substantiate the medical necessity for providing consultative services, explained Kenneth B. Simon, MD, MBA, CMS senior medical officer, in “Medicare Physician Payment Schedule 2010 Changes and Beyond” at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago. If an auditor reviews your hospital code (99221-99233) documentation, different diagnoses will show why more than one physician’s E/M was necessary on the same patient. Next — what auditors WON’T be looking for …

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Medicare Changes to 2010 CPT Inpatient Consultation Codes

Posted on 13. Nov, 2009 by jennifer.godreau.

Prevent 99251-99245 denials in 2010 with this checklist.

Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.

Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles E. Haley, MD, MS, FACP, Medicare medical director for Trailblazer Health Enterprises, LLC, told the audience during the E/M session at the 2010 CPT symposium. “If come January you’re getting denials, work out the issues with your specific contractor.”

You can, however, prevent many rejections from Medicare’s invalidation of 99251-99245 by following this checklist.

√ Use Initial Hospital Day Codes on Day 1

If a physician consults a patient on his first day in the hospital, you should use an initial hospital code (99221-99223), according to Medicare’s new consultation guidelines for 2010. “Stop thinking of these codes as admit codes,” cautioned Peter A. Hollmann, MD, the AMA CPT Editorial Panel, Vice Chair. They are for initial hospital care. “We should say ‘admitting physician’ when we mean just that.

More than one physician can use an initial hospital care code for the same patient. If two physicians from different specialties are both consulting on a patient, both physicians use the initial code. Next, what’s up with modifier AI?

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Medicare 2010 CPT Consultation Code Changes

Posted on 12. Nov, 2009 by jennifer.godreau.

New rules for consult coding straight from the AMA Meeting in Chicago — plus where your practice will gain and lose reimbursement.

If you can’t figure out how to match a low level consult to an initial hospital care code, you’re not alone.

Code 99251 doesn’t crosswalk to 99221, agreed William J. Mangold, Jr., MD, JD, Noridian Administrative Services’ (Arizona, Montana, Utah, Wyoming) Medicare contractor medical director in the carrier response section to Day 2′s opening session at the CPT and RBRVS 2010 Annual Symposium in Chicago. “They don’t have the same criteria.”

Medicare will consider the consult codes (99241-99255) invalid codes for payment, effective Jan. 1. Experts expect some large carriers, including Blue Cross Blue Shield, Aetna, and Humana to adopt the same policy for uniformity. For carriers and private payers that no longer recognize consult codes, let these examples help you decide what code to instead use.

1. Apply Patient Status Rules to Outpatient Encounters

“CMS is saying the consult codes are going away,” Mangold explains. Instead, you should choose the appropriate code based on the applicable guidelines.

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