Wiki Consults Help Please

[byoung15]

I am new to the world of coding. My doctors brought in a consult from a patient that was seen in ICU. Can someone please tell me how to code this? Thanks

 

[Vicky Green]

Consults

If you weren't the admitting doctor then you will bill an Initial visit 99221 through 99223 for any Government plans (Medicare/Access) since they don't pay the consults any longer. Some private payer still pay the Consults 99251 - 99255. Either way they are crossed walked to each other and pay pretty much the same rate under the Federal programs.

The exception:
In my practice if they are established and we are in current treatment for the problem they are being called to evaluate then we bill the subsequent visit codes 99231-99233. The reasoning is that a full HPI/PFSH, etc. is not needed because we already know the patient and problem. It wouldn't be medically necessary to perform that again - therefore you wouldn't meet the requirements for the Inital visit or Consult. A good rule of thumb is if you haven't seen the patient in 90 days or so then you could bill the Inital or Consult.

Hope this helps!