I work in a gastroenterology office (endo suite attached). Can someone give me examples of when they bill for a consultation...and the verbiage that is used in the documentation. I understand the 3 "R's" rule but need assistance on verbiage and when it is a TRUE consult. Thanks so much for any help you can give.
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Wiki Consultation coding
- Thread starter ibtrazy2u
- Start date
Porter_kd
Networker
The very first thing I look at first before I consider the doctor doing a consult code is, what insurance does the patient have? Medicare and Medicaid plans do not accept consult codes. I also believe Healthnet and Humana plans do not accept them as well. I would inform your doctors and learn what insurance companies accept them first. I code from the 2015 AMA CPT book and on page 19 has a great description of what needs to be present in order to bill for consultation codes. Hopefully this helps some.
AmandaW
Guru
Porter, is that every state for Medicaid?
Also, in you guys' opinion, say the note says "Consult" on top and it alludes to it being a "consult" but not all 3 R's were carried out, what would you code it then? A regular admit code (99221-99223) ? Or if it's observation and it's the same scenario then (99218-99220) ?
Also, in you guys' opinion, say the note says "Consult" on top and it alludes to it being a "consult" but not all 3 R's were carried out, what would you code it then? A regular admit code (99221-99223) ? Or if it's observation and it's the same scenario then (99218-99220) ?
Porter_kd
Networker
I am not sure for every state, but I know for Arizona they don't. Their rates are worse than Medicare, so assuming paying for consultation codes don't sound to good. I would go to their website and go to the physician fee schedule. When my physicians get a consultation in the hospital, they state what doctor consulted them, what treatment they provided and they send a copy of what was done to that doctor.. I would make sure the 3 R's were carried out before coding a consult, if not, then code an initial hospital care(99221-99223).
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AmandaW
Guru
Ok, thank you. I could query them when it happens (I HAVE educated them about consults..but...) but sometimes they don't get around to the amendments within timely filing so I wondered about a safe default code. I know 99221-99223 for the Medicares and such.
espressoguy
Guest
Medicaid here in Washington state accepts consults.