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consult and closed fracture treatment by different provider

Karen Posted Wed 08th of March, 2017 18:34:24 PM
I've had this happen a couple times this week. Our hand specialist did a consult on an inpatient with a non-displaced lateral malleolus fracture. Our foot specialist followed up with the patient the next day. Can I do a consult charge with a 57 modifier for the hand specialist and then put the patient in a closed fracture, no manipulation charge with a 90 day global the next day for the foot specialist? He will be the one following the patient.
SuperCoder Answered Thu 09th of March, 2017 02:16:58 AM

If consult codes are accepted by your payer than you can report consult code with 57 modifier for hand specialist.

  • But if  foot specialist treated fracture than you will report appropraite CPT for the treatment for foot specialist but if he has documented the visit than you need to report visit code with modifier 25 and appropriate CPT for fracture treatment.
  • Also, CMS eliminated pay for outpatient and inpatient consultations in 2010.Medicare no longer accepts consult codes, if your doctor is asked to see a Medicare patient for a consult he cannot bill a consult code but can bill an admit code (99221, 99222, CPT 99223 ) .

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