Check your 2010 consultation coding savvy. Answer 1: Check With Your MAC for Guidance When your physician sees a Medicare inpatient and would have used an inpatient consultation code, this year you should report an initial hospital care code (99221- 99223). If the E/M service and documentation do not meet the requirements of an initial inpatient hospital care code, however, your coding will now depend on your Medicare Administrative Contractor's (MAC) or carrier's policy. Problem: Option 1: Some MACs/carriers have stated that you should use the subsequent hospital care codes (99231-99233). "Our MAC (Highmark) has actually stated to not use 99499 (Unlisted evaluation and management service) for consultations and to use subsequent care codes," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network. She adds that instructions about whether or not to use 99499 seem to be MAC-by-MAC specific right now. Option 2: "Check with your contractor," Buechner advises. "Code 99499 is the correct coding choice by CPT rules." Some payers, such as Highmark, don't seem to like that coding, however, so you need to know what code(s) your payers want you to use. Important: Answer 2: Stick With 2 Letters for Admitting Physician Admitting physicians now have a new modifier for their initial inpatient service. As of Jan. 1, if you're billing for the admitting physician you must append modifier AI (Principal physician of record) to the initial visit code. This will denote the admitting physician who is overseeing the patient's care, "as distinct from other physicians who may be furnishing specialty care," according to CMS Transmittal 1875 (www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf). Example: Remember: Answer 3: Skip 99241-99255 for Medicare, Even as Secondary Don't even think about billing a consult to Medicare -- even if the claim is to a Medicare secondary payer (MSP). The challenge: Medicare may have scratched consultations codes off its list of payable services, but many other insurers did not follow suit. This dual system leaves you in a quandary when your physician performs a consultation, and the primary non-Medicare insurer pays for the consultative service, but the secondary payer is Medicare. The MSP "will not pay for consults," says Samantha Daily, a medical biller for a practice in Portland, Ore. Official word: Bill the primary payer using an E/M code (not a consultation code), and then report the amount paid by the primary payer, along with the same E/M code, to the MSP for determination of whether additional payment is due; or Bill the primary payer using a consult code, and then report the amount paid by the primary payer, and change the code to the non-consult E/M code (that is equal to the consultation code/service documented and paid), to the MSP for determination of whether you are owed additional payment. Potential snag: You will need to be able to glean an appropriate E/M code from your physician's consult documentation if the patient ends up also having Medicare as secondary insurance.