Wiki Consultations Medicare POS

Create Wiki
A

alladmins@centralcoastortho.com

New
Messages
7
Location
Pismo Beach, CA
Best answers
0
We are a Ortho group and our providers do consultations. For our Medicare patients in 2023, what series of consult codes are used for each of the following (including initial & subsequent): POS 11, POS 21, POS 22, POS 23, POS 24?
I do not need help deciding what a consult is and I don't need help deciding the Place of Service. I know both of those. It's what series of Medicare covered consult codes am I looking for in each place of service that I would truly appreciate help with. I am trying to create a 'quick reference guide' for our charge entry staff to help eliminate the many denials I'm working. Thank you for your time :)
 
Medicare stopped covering the actual consultation E&M codes 99242-99245 (office/outpatient) and 99252-99255 (inpatient/observation) effective 01/01/2010 per Medicare Claims Processing Manual Chapter 12-Physician/Nonphysician Practitioners 30.6.10-Consultation Services. The manual provides the following instructions on what E&M codes to bill in the place of the consult CPT codes 99242-99245 & 99252-99255:
1703881825286.png
This section of the manual goes on to indicate what CPT codes are to be used for E&M services based on the whether the services were rendered in the inpatient or office/outpatient setting. For inpatient services the codes for initial and subsequent visits codes and for office of outpatient services new and established patients codes ranges are listed as well. The subsequent section of the manual 30.6.11-Emergency Department Visits regarding E&M services for various E&M scenarios in the ED.

You should be able to find the various E&M codes you asked about in your post in these sections of the manual.
 
CBLENNIE said:
Medicare stopped covering the actual consultation E&M codes 99242-99245 (office/outpatient) and 99252-99255 (inpatient/observation) effective 01/01/2010 per Medicare Claims Processing Manual Chapter 12-Physician/Nonphysician Practitioners 30.6.10-Consultation Services. The manual provides the following instructions on what E&M codes to bill in the place of the consult CPT codes 99242-99245 & 99252-99255:
View attachment 6696
This section of the manual goes on to indicate what CPT codes are to be used for E&M services based on the whether the services were rendered in the inpatient or office/outpatient setting. For inpatient services the codes for initial and subsequent visits codes and for office of outpatient services new and established patients codes ranges are listed as well. The subsequent section of the manual 30.6.11-Emergency Department Visits regarding E&M services for various E&M scenarios in the ED.

You should be able to find the various E&M codes you asked about in your post in these sections of the manual.
Click to expand...
Thank you so much! This is exactly what I was asking and I will research the manual section you mentioned :)
 
This is always a common issue because newer coders or folks not used to E/M will see the words "consult" when the ortho provider is called in and try to code a consult 9924_ or 9925_. In an ortho group I worked in, we had an internal edit for MCR & payers that don't accept consults to stop it before going anywhere. If you are getting denials, look into, or contact your manager, or practice management supervisor to stop these at the scrubber before they make it out the door.
The providers will usually call it a consult in their documentation because that's what it is. It was a constant training/reminder point for coders. Some Medicaid plans and Work Comp may still accept consult codes. Just depends on payer.
AAOS might have decision trees, info: https://www.aaos.org/quality/coding-and-reimbursement/coding-community/
You would switch to the 99202-99215, 99221-99223, 99231-99233, etc. codes depending on disposition and place of service. It can also depend on if it was a true consult (referring provider asking for consulting provider opinion and report back) or not and/or transfer of care, etc. Did the ortho admit the patient to IP, did they see them in the ED only, was it observation, etc.... questions to ask before coding a certain E/M.
 
amyjph said:
This is always a common issue because newer coders or folks not used to E/M will see the words "consult" when the ortho provider is called in and try to code a consult 9924_ or 9925_. In an ortho group I worked in, we had an internal edit for MCR & payers that don't accept consults to stop it before going anywhere. If you are getting denials, look into, or contact your manager, or practice management supervisor to stop these at the scrubber before they make it out the door.
The providers will usually call it a consult in their documentation because that's what it is. It was a constant training/reminder point for coders. Some Medicaid plans and Work Comp may still accept consult codes. Just depends on payer.
AAOS might have decision trees, info: https://www.aaos.org/quality/coding-and-reimbursement/coding-community/
You would switch to the 99202-99215, 99221-99223, 99231-99233, etc. codes depending on disposition and place of service. It can also depend on if it was a true consult (referring provider asking for consulting provider opinion and report back) or not and/or transfer of care, etc. Did the ortho admit the patient to IP, did they see them in the ED only, was it observation, etc.... questions to ask before coding a certain E/M.
Click to expand...
Thank you Amy! I appreciate your help so much. One thing I love about being a coder and this forum is the amazing support we get from others here :)
 
You must log in or register to reply here.
Top