Wiki admit codes---confused again

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KHH

KHH

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My Dr saw a new patient in office with BCBS of SC and he admitted her, what code would use, or give me some understanding so I can understand it myself. I know about use AI but the actual code is in question he wants to use 99223 and I think we should use 99254-AI HELP please :confused:
 
I was always told by our Medicare rep "It's where your physicians feet are when it comes to admitting patients from the office" So if he admits a patient from his office then you would bill an office code, 99213 etc and the physician at the hospital will bill the admit code. If he was at the hospital and admitted the patient then you would bill the 99221-99223AI but not both.

Now with the consultation code (99254), which physician did he consult? If he didn't then you would bill the 99221-99223AI. You would have to check with your payer if you decide to bill 99254 due these codes being deleted from most of your Medicare's and HMO's fee schedule.

There is a crosswalk for your old 99251-99254 to the 99221-99223 conversion for billing consults.

If anyone has any conflicting information, I'd love to know if I'm not understanding the scenario.
 
Consult codes for inpatient, not admitting doctor

If anyone can help clarify, I need help in understanding coding for inpatient hospital consults. My physician was consulted for an inpatient at a hospital and since consult codes were all but eliminated, I need some assistance.

Thank you.
 
ngenschaw said:
If anyone can help clarify, I need help in understanding coding for inpatient hospital consults. My physician was consulted for an inpatient at a hospital and since consult codes were all but eliminated, I need some assistance.

Thank you.
Click to expand...

That will depend on the payer. Consult codes have not been eliminated--all of our commercial payers still accept them.

IF the patient has a commercial payer that still accepts consults, you will use codes for 99251-99255 for an inpatient consult.
IF the payer is Medicare, a Medicare replacement, any other government-based payer, or any other payer that will not accept consults, you will use a code from the Initial inpatient visit codes, 99221-99223. This is the same codeset that the admitting physician uses, but the admitting uses the AI modifier with their code to differentiate.

HTH!
 
99254 is a consultation code...so the question is did he do an H&P or an actual consultation at the request of another doctor. If no request from other provider then it would be accurate to bill 99221-99223 with an AI modifier
 
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