Pediatric Coding Alert

You'll need to follow 2 guidelines unless insurers kiss 99241-99255 good-bye. Although CPT clarifies the transfer of care definition, the fix came too late for Medicare. Your private payers may follow suit. Embrace E/M Boom From Continued Errors The Office of Inspector General found a high error rate on appropriate use of consultation codes. Different opinions on when a transfer of care occurs versus a consultation caused $1.1 billion in incorrect payments. "We couldn't even all agree on some scenarios," admitted William J. Mangold Jr., MD, JD, Medicare contractor medical director of Noridian Administrative Services (Arizona, Montana, Utah, Wyoming) in a session at the CPT and RBRVS 2010 Annual Symposium in Chicago. Pediatricians who don't regularly code consults could gain from Medicare's position related to inconsistent and invalid codes for payment in 2010. CPT still considers the codes valid. CMS, however, will take the payments for 99241-99255 (Consultations) and redistribute [...]