Kim Posted Wed 11th of September, 2019 17:51:42 PM
If a speciality provider does a consultation on a patient admitted to the hospital and it is the first time this provider has seen the patient for this admission, is it appropriate to bill CPTs 99221-99223? There is conflicting information between the CPT book, insurance manuals, and even on this website concerning this issue. We've read that only the admitting physician can bill the initial hospital care codes but the Medicare Claims Processing Manual states "Physicians may bill initial hospital care service codes (99221-99223), for services that were reported with CPT consultation codes (99241 - 99255) prior to January 1, 2010". Please advise on the correct way to code a consultation, specifically for insurances that do not accept consultation codes (99251-99255), by a non-admitting provider. Thank you.
SuperCoder Answered Thu 12th of September, 2019 05:20:22 AM
Hi Kim Effective January CPT consultation codes were no longer recognized for Medicare Part B payment In revisions to Consultation Services Payment Policy it is published that you must code patient evaluation and management visits with E M codes that represent where the visit occurred and that identify the complexity...