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Using code 99244 for a new pt. visit vs. 99203

Salma Posted Fri 07th of January, 2011 14:30:24 PM

One of my endocrine specialist wants to use 99244 for all new pt. instead 99204. Is that right? he thinks that pt are coming in for consult since he is a specialist. Also, I heard that medicare has changed the T-file to 90 days, is that true?

SuperCoder Answered Fri 07th of January, 2011 19:58:35 PM

As long as Criteria of Consult is justified and the patient is a New Patient, then it's appropriate to use 99244.

All claims with service dates prior to 1/1/2010 must be submitted prior to 12/31/2010 and will be processed according to the old guidelines. All dates of service 1/1/2010 and after will be subject to the new guidelines and will only be allowed within one calendar year.

This new ruling affects all Medicare provider types. It affects all physicians, providers and suppliers that submit claims to Medicare contractors including durable medical equipment suppliers, home health, Medicare Parts A & B. Basically anyone who provides services to Medicare beneficiaries and submits claims for those services.

If you follow some key guidelines you should not have any problems even under the new edits. Claims should be submitted as close to the date of service as possible. If submitting electronically, electronic reports should be read and acted upon. Whether submitting on paper or electronically, follow up or aging reports should be run regularly and worked on. Any claims over 20 days if submitting electronically and 45 days if submitting on paper should be checked on. Any denials received by Medicare should be acted upon quickly. If there is something that can be corrected, fix it and rebill quickly. If it is a patient issue, bill the patient so that they can handle anything from their end that needs to be done. This allows time to resubmit if necessary.

SuperCoder Answered Sat 08th of January, 2011 15:32:37 PM

99244 would be a consult they would need a reff doctor another doctor has reffered them. 99204 is a new pt maybe they heard the doctor was great and called on there own that would would be a new pt

SuperCoder Answered Sat 08th of January, 2011 19:33:45 PM

That is why I mentioned to justify the Criteria of Consultation:

The three criteria for a consultation are stated in the MCM :

1. A consultation is distinguished from a visit because it is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate choice.

2. A request for a consultation from an appropriate source and the need for consultation must be documented in the patient’s medical record.

3. After the consultation, the consulting physician prepares a written report of findings that is provided to the referring physician.

In no other situation can you use Consultation codes.

I also would like to add to content for my answer regarding new Medicare TF:
The Patient Protection and Affordable Care Act (PPACA), signed into law March 23, 2010, establishes new timely filing provisions for filing Medicare fee-for-service (FFS) claims (including Medicare Part A and Medicare Part B services), which could significantly affect health care providers.
Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year of the date of service. The law also mandates claims for services furnished before January 1, 2010, must be filed by December 31, 2010.

Examples include:
A claim with dates of service from September 1, 2009, through September 27, 2009, must be submitted by December 31, 2010.
A claim with dates of service from November 3, 2008, through November 20, 2008, must be submitted by December 31, 2010.
A claim with dates of service from November 3, 2009, through November 20, 2009, must be submitted by December 31, 2010.
A claim with dates of service from February 4, 2010, through February 28, 2010, must be submitted by February 28, 2011.
Although PPACA does allow for very limited exceptions to the one-year filing deadline, as a practical matter, fee-for-service providers should plan to file all claims with pre-January 2010 dates of service by December 31, 2010.

Emily Answered Tue 09th of August, 2011 01:04:44 AM

Prior to 2010, our billing system uses consult codes 99244 (outpatient/observation status) and 99254 (inpatient consults).
I went to a seminar and I was told (or they way i understood it) was to substitute/crossover (of couse, depending on the bullets and complexity, to adjust the codes up or down) as ff:

99222/99223 for inpatient consults
99204/99203 for outpatient consults

I did not take into consideration if it was an established patient and had used 99204 for observation status consults regardless of new or established patients, since under the old system 99244 is used everytime observation status patient consulted our physician.

It seems like I had misunderstood and should have used 99215 for observation consults of established patients.

Please clarify.

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