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E&M Emergency Rm Coding

Shirley Posted Tue 14th of February, 2012 17:31:06 PM

The billing clerk is telling us that Medicare B will no longer pay for consultation codes on patients in the ER dept. Is it still the rule that Medicare patients seen by other than the ER physician are coded using the '99201-99205' or '99241-99245' if the patient has Medicare A or B? Please clarify.

SuperCoder Answered Tue 14th of February, 2012 17:51:52 PM

Exactly true, billing clerk is correct. Medicare is not recognizing consult codes, including outpatient consultation codes 99241-99245. Therefore, physicians who are seeing Medicare patients as consultants during a hospital observation stay should be billing the new patient outpatient evaluation codes 99201-99205.

AAOS link:
http://www.aaos.org/govern/state/organizationaltools/newsletters/AAOSStateNewsletter_January.pdf
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CMS link:
https://www.cms.gov/MLNMattersArticles/downloads/MM6740.pdf (search with--This article pertains to Change Request (CR) 6740)

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