They wont know. The correct inpatient consultation codes for a first evaluation are 99221-99223. For an inpatient service, use the initial hospital services codes (9922199223). Hope this helps! See Medicare Claims Processing Manual: Chapter 12, Page 40 for Observation consult coding advice. 234 0 obj 0000003850 00000 n endobj CMS is not planning on changing its policy on consultations. Incidental Procedure Codes (PDF, 73 KB) endobj She has been a self-employed consultant since 1998. 0000003954 00000 n CPT 96040 Genetic Counseling (time-based, face-to-face time) is also in the CPT set of codes that can be . They set up an edit in their system so that consult codes can be reviewed and cross walked to the appropriate code, depending on the payer. But, the correct category of code is initial hospital care. For the IP scenario only you would add modifier AI if your provider was the admitting and/or attending physician who oversees the patient's care, as distinct from other physicians who may be furnishing specialty care. 0000003057 00000 n Because the depression screening does not require an interpretation and report, it is not separately paid by this payer. 0000012036 00000 n xref C CatchTheWind Guest 226 0 obj Thanks for your help, Copyright 2023, AAPC endobj To ensure proper reimbursement, allergists should follow applicable, payer-specific policies governing the use and reporting of consultation codes (99241, 99242, 99243, 99244 and 99245). Services initiated by a patient and/or family and not requested by a physician or other appropriate source should not be reported using CPT consultation codes 99241-99245 or 99251-99255 or HCPCS consultation codes G0406-G0408 or G0425-G0427, but may be reported using appropriate office visit, hospital care, home service or domiciliary/rest home Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding. Assuming you meet the coding definition of consult, if 98% of your consult codes get denied, that does not seem like a great way to get paid. In 2023, codes 99241 and 99251 are deleted. Do not use CPT consultation code ranges 99241-99245, 900-3925-0617 99251-99255 or HCPCS consultation codes G0406-G0408, G0508, G0509 or G0425 . First, CMS stopped recognizing consult codes in 2010. They published this in July 2008 and all societies were aware of the change coming. 257 0 obj 0000003902 00000 n <> 221 0 obj She knows what questions need answers and developed this resource to answer those questions. How will clinicians know if the payer recognizes consults? Earn CEUs and the respect of your peers. According to CPT, these codes are used for new or established patients. Outpatient consultations (9924199245) and inpatient consultations (9925199255) were still active CPT codes, and depending on where you are in the country, are recognized by a payer two, or many payers. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. The following are the most common reasons HCFA/CMS-1500 and UB/CMS-1450 paper claims for Veteran care are rejected: Requires the 17 alpha-numeric internal control number (ICN) [format: 10 digits + "V" + 6 digits] or 9-digit social security number (SSN) with no special characters. 235 0 obj [278 0 0 556 0 0 667 191 333 333 0 0 278 333 278 278 556 556 556 556 556 556 556 556 556 556 278 0 0 0 0 556 0 667 667 722 722 667 611 778 722 278 500 0 0 833 722 778 667 778 722 667 611 722 667 944 0 0 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 0 500 222 833 556 556 556 556 333 500 278 556 500 722 0 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 737] endobj The use of Coding Policy is not intended to replace independent medical judgement for treatment of individuals. hb```b`` @QRy`2I&iLKHbD` juqh Q` 0WLedE,Zs]q2hG1~. me/_ onuxT|W8v1Y,r[qoL9NWpSS'9+y^h\nD*c4[=q.q4w:@]$Lu(Bg`E9z7^S$i+d*,Si7``*MIUoUky4>NDm,j>Pab;X,#bFrx>rUI W-S+|:drFOqyk ~3sHm9p3iX~.JZ,B;t,IdDMRw"JA?6X6ifg|. 0000002225 00000 n Cigna will become the second payer to discontinue payment for consultation services in 2019. I dont have an answer to give them because I am getting a lot of conflicting info. <>/Metadata 24 0 R/Pages 23 0 R/StructTreeRoot 26 0 R/Type/Catalog/ViewerPreferences 221 0 R>> 231 0 obj B{rZyNR EA kH:VuI`uy3ITs2R]2rlS!>Q`ZZpW#=Q;^hRLf$Az\* 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. 0000026814 00000 n 0000005607 00000 n Oh wellI guess all these changes are good for our brains! endobj 0000028473 00000 n After CMS eliminated the codes Jan. 1, private payers could choose to continue reimbursing the codes or follow CMS's lead. CPT instructions do state that the consultation codes 99241-99245 may be used for consultations services in the ER, so that would be correct for payers that still accept those codes. 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