Everything about Consult Codes

Everything about Consult Codes

Everything about Consult Codes

One of the biggest challenges in CPT codes 2010 is how to code consults. Medicare has removed consultation codes from CPT's 99241-99255 section. This implies, when you're billing Medicare, you'll be required to find other codes to indicate what used to be consults. At the same time, some non-Medicare payers will still accept consultation codes.

The following 10 steps would help you to overcome the challenge of code consults in CPT codes 2010 and at the same time help you to get paid and stay compliant:

1. Get ready to see other large payers follow Medicare's lead and boycott these consult codes as well.

2. Check which of your payers continue to accept consult codes.

3. While billing for Medicaid, check with your state for consult codes instructions, non acceptance by Medicare doesn't imply things are same for Medicaid across the board.

4. When two or more physicians see a patient during his hospital stay, make sure the ICD-9 codes and/or the physician notes justify the need for two or more physicians.

5. Avoid using CPT 99221-99223 as 'admit codes.' If a physician consults the patient on first day in the hospital, you should apply an initial hospital code. If there are more than one physician, they can apply an initial hospital code for the same patient, keeping #4 in mind.

6. The use of modifier AN' designates the doctor as the admitting physician while billing Medicare.

7. At higher levels, the consults' transfer to the hospital care codes will benefit your practice's profit. You could gain approximately 30 percent in pay if you report the prolonged services with 99244 and 99245.

8. Don't expect reimbursement to be higher for lower-level hospital inpatient visits which, under Medicare's old system, would have been consults.

9. Always focus on total work while coding for shared/split inpatient visits for Medicare.

10. Use new/established patient rules while coding visits that would have been consults under the Medicare's old rules.

For more information on CPT codes 2010 and to get consult code updates sign up for various one-stop medical coding websites.

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