PDF Payment Policy: Physician's Consultation Services - Superior HealthPlan For more about Betsy visit www.betsynicoletti.com. Don't forget since consults still use the 95/97 guidelines, you may frequently get a higher level with 99202-99215 if your clinician misses an exam bullet point or doesn't completely document a history. C CatchTheWind Guest 235 0 obj Some payers may not agree with the advice given. CPTcodes identify a particular procedure or service If a specific CPTdoes not exist that identifies the procedure or service, an unlisted code must be utilized Coding is the translation between the physicians written word and the dictionary used by payers to interpret them into numbers What Do the Codes Say? endobj In a shared medical record, this can be done electronically. Starting March 1, 2022, we will no longer pay office consultation codes 99241, 99242, 99243, 99244 and 99245. 0000028068 00000 n <> Office consultation codes payment update - Aetna Coding Corner: How to report a consult service when your - cmadocs If you provide consultations to Cigna members, be aware that Cigna will soon no longer pay those codes. How will clinicians know if the payer recognizes consults? Coding Consultation E/M Services Correctly - AHIMA Invalid Service Facility Address. Coding has a direct affect on reimbursement. While we think of them and even talk about them as admission codes, CPT doesnt use that word. Another example of upcoding related to E&M codes is misuse of Modifier 25. Watch out with BCBS especially because if you code an initial hospital visit when it was actually a consult (as is the common practice with any other payer), they will recoup their payment and you'll have to resubmit a corrected claim. Cigna will become the second payer to discontinue payment for consultation services in 2019. endobj xref hbbe`b``3 b Consultations in 2023 - KarenZupko&Associates, Inc. Physicians may report a subsequent hospital care CPT code for services that were reported as CPT consultation codes (99241 99255) prior to January 1, 2010, where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the providers first E/M service to the inpatient during the hospital stay. 223 0 obj CPT 96040 Genetic Counseling (time-based, face-to-face time) is also in the CPT set of codes that can be . startxref If the documentation doesnt support the lowest level initial hospital care code, use a subsequent hospital care code (9923199233). 0000004290 00000 n It can affect the timeliness and accuracy of claim payments. Use either medical decision making or the practitioners total time on the date of the visit to select the level of service. Check Payer Policies for Consult Code Coverage, Tech & Innovation in Healthcare eNewsletter, Ask 3 Questions to Head Off 2010 Consult Problems. For Medicare, which does not accept consultation codes, guidelines state that you are required to use 99281-99285, as the post above indicates. Please recall that CMS/Medicare and several other payers still do not recognize or accept consultation codes, and we do not anticipate that this would change during a public health emergency. <> If the initial inpatient or observation care service is a consultation service the consultant should report subsequent hospital inpatient or observation care codes 99231-99233. . Use these codes for consultations for patients in observation as well, because observation is an outpatient service. The statement that I recommend is I am seeing this patient at the request of Dr. Patel for my evaluation of new onset a-fib. At the end of the note, indicate that a copy of the report is being returned to the requesting clinician. Does anyone have a list of commercial insurance companies that are still accepting consult codes and one that are following medicare guidelines? The appropriate follow up codes for the hospital setting are CPT codes 99231-99233, and the appropriate . 229 0 obj In the past, the codes 99221-99223 were used only for the admitting physicians, and the codes 99251-99255 were . 0000010821 00000 n Neglecting to bill consults when the carrier pays them results in lost revenue. 0000003850 00000 n hb```b`` @QRy`2I&iLKHbD` juqh All content on CodingIntel is copyright protected. 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