Medicare Compliance & Reimbursement

With Medicare Part B now refusing to reimburse for consultation codes, some physician practices feel left in the lurch. Get to know how you'll code these scenarios now that you can't collect for consults anymore. Read the following four E/M and consultation coding questions and determine how you would answer them before you turn to page 22 for the answers.

If your physician documents a service that you previously would have coded as a consultation, how should you report it to Part B now that consult codes are obsolete in Medicare's eyes?

When a specialist sees a patient in the hospital at the request of another physician and you know it's a service that would previously have billed as a consult, should you report an unlisted E/M code (99499) for the service, rather than billing an inpatient E/M visit code?

If your physician sees a patient in the hospital at the request of the patient's attending physician, should you append modifier AI (Principal physician of record) to your claims? And in what scenarios is modifier AI appropriate for Medicare payers?

Suppose your documentation would have supported a level-three outpatient consultation (99243) per AMA CPT guidelines. Can you simply bill a level-three outpatient visit (99213) now that Medicare doesn't accept the consultation codes? Or are level transfers not acceptable?

Think your answers are right on the money? Turn to page 22 to determine whether your coding accuracy is right on target or whether you need to update your skills before billing Medicare using the new 2010 rules.