# Consults for 2010



## Gemini18 (Dec 7, 2009)

I know consultation codes are being eliminated, starting January 2010.  

My question is -- What are we going to bill?  I was told we are suppose to use initial inpatient -- can someone verify this?  I did not see anything on the CMS website.  I have seen plenty of blogs but they are just as confusing.  Can someone point me in the right direction?

Thank you so much.

Karen


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## mitchellde (Dec 7, 2009)

The final rule tells us that the admitting physician will bill his initial visit with an A1 modifier and then when the consultant is called in he will bill an initial visit code (regardless of whether this is day 1 or day 5) with no modifier.  Thw office visit consultations will be replaced with new or estb visit levels.


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## Lisa Bledsoe (Dec 7, 2009)

Not that our opinion counts, but wouldn't it be easier to have the consultant use a modifier?  Just a thought.


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## mitchellde (Dec 7, 2009)

I had to chuckle at this also.  It would have been easier if they had asked us first!


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## j.berkshire (Dec 7, 2009)

Note, the modifier for the admitting physician of record is AI (a-eye), not A1.  Check your HCPCS book or CMS website for the description of both modifiers.  This is a common misinterpretation and I bet it causes a lot claims filing errors in January!


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## mitchellde (Dec 7, 2009)

I thought the same thing but it did look like a 1 in the transmissions I read and then I saw one print it out as A one so now I wonder.  How confusing all of this is!


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## j.berkshire (Dec 7, 2009)

Here is the description of both modifiers from CMS's site ( http://www.cms.hhs.gov/HCPCSRelease...descending&itemID=CMS1230217&intNumPerPage=10)


AI	00100	7	PRINCIPAL PHYSICIAN OF RECORD	Principal physician of rec	
   A1	00100	7	DRESSING FOR ONE WOUND	Dressing for one wound


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## Gemini18 (Dec 7, 2009)

mitchellde said:


> The final rule tells us that the admitting physician will bill his initial visit with an A1 modifier and then when the consultant is called in he will bill an initial visit code (regardless of whether this is day 1 or day 5) with no modifier.  Thw office visit consultations will be replaced with new or estb visit levels.




So to make sure I FULLY understand -

Dr. A -- 99223-AI
Dr. B -- 99223 (consulting dr)?

Is this right?


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## mitchellde (Dec 7, 2009)

I just looked at the earlier transmittal I got and it does look so much like a 1 but clearly this is the lates on this and it is an AI.  Thank you so much that really helps.


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## mitchellde (Dec 7, 2009)

Gemini18 said:


> So to make sure I FULLY understand -
> 
> Dr. A -- 99223-AI
> Dr. B -- 99223 (consulting dr)?
> ...



That is the way I read it!


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## Gemini18 (Dec 7, 2009)

mitchellde said:


> That is the way I read it!



Thank you so much!  

Where did you see it on the CMS website? Can you please send me the link.


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## angela1 (Dec 7, 2009)

*2010 consult who knows?*


So What if Docs hold the billing because they don't want it to hit the deductible?  Also what happens if the Docs that do the initial admit forget to put the modifier?  In addition what happens if the doc who is supposed to bill for the admit does not?  Are they planning to keep it in review forever?  
What do we do for Commercial and HMO carriers are they going to follow the Medicare rules?  What about Medicare HMO's do you or don't you?  

HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!


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## rinny (Dec 7, 2009)

I don't know whether to laugh or cry

Should the modifier be added on *all* admits in order to keep the charge from going to review in case a consultant bills their visit first?

I just see so many problems.  I guess the best thing to do is, buckle up and keep hands in the ride at all times

rinny


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## RebeccaWoodward* (Dec 7, 2009)

angela1 said:


> So What if Docs hold the billing because they don't want it to hit the deductible?  Also what happens if the Docs that do the initial admit forget to put the modifier?  In addition what happens if the doc who is supposed to bill for the admit does not?  Are they planning to keep it in review forever?
> What do we do for Commercial and HMO carriers are they going to follow the Medicare rules?  What about Medicare HMO's do you or don't you?
> 
> HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!



Yes...I have heard that if the admitting physician fails to append the AI modifier to their claim, all others will be held for review.  As for commercial carriers, I have only heard of one that will follow MCR's lead.  I have many, many questions too.  Waiting patiently for Medicare to publish a CR...


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## dentfam (Dec 7, 2009)

*Consult Question...ABN?*

So here's a question...
if Medicare no longer pays for consults does that mean that we could have the patient sign an ABN and bill to the patient like we do for Medicare and physicals?


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## RebeccaWoodward* (Dec 7, 2009)

I don't think so...

Medicare has a crosswalk for the "former" consultation codes.  If they were medically necessary in the past, they should be medically necessary now...


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## mitchellde (Dec 7, 2009)

dentfam said:


> So here's a question...
> if Medicare no longer pays for consults does that mean that we could have the patient sign an ABN and bill to the patient like we do for Medicare and physicals?



I do not think so either. If you read careful the issue is not that Medicare will not pay for these services it is that they are considering the codes for consultation as invalid codes therefore you could not bill an invalid code and then bill the patient when denied by Medicare.  Consultation services are still recognized services just coded as either new or established or in the case of inpatient as initial visit.


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## cpccoder2008 (Jan 4, 2010)

So what about follow up inpatient visit's from the cosulting ? Would you code the initial admit for the cosult and then follow up inpatient visit's after ?


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## mitchellde (Jan 4, 2010)

yes and you get to bill for one initial level after that all are subsequent there will be no reconsulting the same physician for a new problem in the same admission.


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## Cyndi113 (Jan 4, 2010)

One of my MDs just came in and said that Congress is delaying the change. Can anyone confirm or deny? I've been googling and checking CMS and can't find anything. I think its just wishful thinking on his part.

Thanks!


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## mitchellde (Jan 4, 2010)

there is nothing to suggest this is not in effect as we speak (type).


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## Cyndi113 (Jan 4, 2010)

I thought so.

Thanks!!


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## cheermom68 (Jan 5, 2010)

*consults*

During a CMS open door forum,  they stated that claims will not be held pending the billing of an AI modifier.  So even if the admitting physician never bills it should not affect payment for anyone else.  They also stated with an emphatic NO that you cannot have an ABN signed nor balance bill the patient.  The question about Congress is referring to an amendment that was supposed to be added to a bill, however last I heard the amendment was never added, so my guess is that it is a null issue unless we hear differently, no consults to regular Medicare.


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