Wiki Consult confusion!

[jdibble]

I previously worked in NJ as an auditor and physician educator for a hospital owned physician practice and when I left (January 2014) we were still billing commercial insurances for consults. I recently started working for a hospital owned physician practice in FL as a coder/auditor and am confused about consult codes for commercial carriers. I have been assigning consult codes for patient's with commercial insurance and now the billing company is sending them back saying those codes are not valid.

Did I miss something in the past few months? Have all insurances stopped accepting consult codes? If not, does anyone know which ones still accept them or how I would go about finding that information? And if some insurances still do accept the consult codes, do you know if they will pay for more than one Initial Inpatient visit if it gets billed as that rather than a consult? Or an outpatient visit code for Observation patients?

I am confused now on how to code these visits so any guidance or help on where to get answers would be appreciated!

Thanks,

 

[mhstrauss]

I previously worked in NJ as an auditor and physician educator for a hospital owned physician practice and when I left (January 2014) we were still billing commercial insurances for consults. I recently started working for a hospital owned physician practice in FL as a coder/auditor and am confused about consult codes for commercial carriers. I have been assigning consult codes for patient's with commercial insurance and now the billing company is sending them back saying those codes are not valid.

Did I miss something in the past few months? Have all insurances stopped accepting consult codes? If not, does anyone know which ones still accept them or how I would go about finding that information? And if some insurances still do accept the consult codes, do you know if they will pay for more than one Initial Inpatient visit if it gets billed as that rather than a consult? Or an outpatient visit code for Observation patients?

I am confused now on how to code these visits so any guidance or help on where to get answers would be appreciated!

Thanks,

Pretty much all of our commercial payers still allow consult codes, both inpatient and outpatient...Blue Cross of LA, Humana, Aetna, Humana, United Healthcare, Coventry. The only payers I'm aware of that do not accept them are Medicare, Medicaid, Tricare...the government-related payers. Sounds like a problem with the billing company, unless things changed specifically in FL ??

 

[jdibble]

Thanks Megan - that is what I thought, but since I am new to Florida I am not sure if that is possibly the case. I am trying to research it but am hitting walls as far as where to go to find out that information! If you or someone can guide me as to where I would find out this information for sure I would love to present that to the billing company so that I know that we are billing correctly for these visits!

Thanks for your help!

 

[mhstrauss]

Thanks Megan - that is what I thought, but since I am new to Florida I am not sure if that is possibly the case. I am trying to research it but am hitting walls as far as where to go to find out that information! If you or someone can guide me as to where I would find out this information for sure I would love to present that to the billing company so that I know that we are billing correctly for these visits!

Thanks for your help!

I would check the website of maybe the 2 or 3 most prominent commercial payers in the state. See if they have coverage guidelines, and if the consult codes are still on their fee schedules. Even better if you can get it all in writing from a provider rep. If you can confirm with even just a couple payers that consults are still accepted, there's your proof that the problem is in the billing company. Just a start...

 

[jdibble]

Thanks Meagan! I will try that!

 

[lsauseda]

I live in rural Ks and have also been encountering difficulties getting consults paid. The one of main concern this week has been blue cross. They told my blue cross clerk that NO consults will be paid going through the Topeka office. They told us the physician who admits the pt will get the admit code and if another physician sees the patient on the same day we have to bill a subsequent visit.
I've been looking for answers also. Its becoming quite frustrating.

 

[jdibble]

I live in rural Ks and have also been encountering difficulties getting consults paid. The one of main concern this week has been blue cross. They told my blue cross clerk that NO consults will be paid going through the Topeka office. They told us the physician who admits the pt will get the admit code and if another physician sees the patient on the same day we have to bill a subsequent visit.
I've been looking for answers also. Its becoming quite frustrating.

That does not make any sense! I understand if they will no longer will accept a consult code, but Medicare guidelines tell you to use an admit code for a consult unless it was a lower level consult, then you would use a subsequent code. If a provider is doing all of the work for a level 2 or 3 consult, why should they only get paid for a subsequent visit?

At this point it would be easier if all insurances decided to follow CMS and not pay consult codes! Then we wouldn't have to question what to do and claims would not be getting denied!