Jennifer Posted Thu 13th of June, 2013 13:58:43 PM
MY DOCTOR SAW A PATIENT IN THE HOSPITAL AND DID A LOW LEVEL CONSULT WHICH I WOULD NORMALLY CODE AS 99232 SINCE EXAM & DOCUMENTATION WAS LIMITED (PT WITH DEMENTIA AND RECTAL BLEED). HE THEN STATED "COLONOSCOPY IF BLEEDING CONTINUES.) THIS IS A NEW PT TO OUR PRACTICE. A COLONSCOPY WAS THEN DONE ON THE SAME DAY. I AM NOT SURE HOW TO CODE THE CONSULT SINCE I WILL BE BILLING PA MEDICARE. IF I USE THE 99232 IT WILL DENY SINCE SUBSUQUENT CODES CANNOT BE BILLED IN ADDITION TO PROCEDURE ON SAME DAY. MAYBE MODIFIER 57 ADDED TO CONSULT?
SuperCoder Answered Thu 13th of June, 2013 23:16:48 PM
A consultation can be provided for a new patient or an individual previously seen, if the service meets the requirements for consultation, so “new” isn’t a key concept here; however, CPT recognizes only one consultation per admission in the inpatient setting, other services being subsequent hospital care. If the consultation assessment led to the conclusion that an endoscopic procedure was needed same day, the procedure would be billed without modifier, and the E&M visit with the –25 modifier indicating “separately identifiable E&M service.” Some non-Medicare payers still do not recognize the E&M service, which should be appealed; and still can be charged to the patient. .Most of the largest national payers have settled class action suits brought by state medical societies in which they have agreed to abide by recognized CPT coding and CMS payment conventions.
Note that if the procedure was planned and the evaluation was just to assess stability for the procedure or provide the administratively required H&P for a facility, no separately identifiable E&M service has been provided, since procedures have an element of E&M work also.