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Hospital Consults

Debbie Posted Tue 28th of May, 2013 20:25:41 PM

What code do I use if our doctor is called in for a Hospital Consult for Medicare, if we are NOT the admitting physician? I though we should be using 99221-99223, but now Medicare is denying our claim saying another physician has billed for this service.

SuperCoder Answered Wed 29th of May, 2013 15:45:41 PM

It sounds like 99221-99223 were the proper codes if the patient has straight Medicare or if the payer follows Medicare's guidelines (such as the elimination of consultation codes). You shouldn't need a modifier. The admitting physician can also use these codes with modifier AI appended. Only the admitting physician uses AI. My suggestion is to make sure no one else within the group/specialty also saw the patient during the stay and billed the initial inpatient. If that did happen, your coding should change to 99231-99233. If the payer doesn't follow Medicare guidelines, you should use 99251-99255 for the consultation, of course.

Thanks,
Leesa

Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions

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