Wiki Consults

[cpccoder2008]

Now that medicare no longer pays consults you use 99221-99223 for inpatient consultations but do you still put a reffering doctor ? If you do not put one will it deny ?? I would say it's informational and wouldn't affect reimbursement or denials but would like additional feedback, I have been putting them and no problems yet. Thanks

 

[capricew]

Now that medicare no longer pays consults you use 99221-99223 for inpatient consultations but do you still put a reffering doctor ? If you do not put one will it deny ?? I would say it's informational and wouldn't affect reimbursement or denials but would like additional feedback, I have been putting them and no problems yet. Thanks

from what i have seen, the consult code is for all physicians including the admitting physician. If you are billing for the admitting physician then a modifier goes on you consult code to state that you are the original physician, therefore i do not believe all the other physicians would need to indicate on their claim who the admitting/referring dr is.

 

[mitchellde]

99221-3 are not consult codes, they are initial inpatient visit levels. They are the levels you use for Medicare consults and all other carriers following Medicare policy on consults. The AI modifier is used on the initial inpaitient visit level if your physician is the admitting physician. The consulting physician uses no modifier. As far as putting the referring physician info on the claim, I say yes as CMS indicated in November of 09 that you should still capture the documentation and claim information the same as if you were billing consult codes as you may need that information in case an appeal is necessary.

 

[RebeccaWoodward*]

I agree with Debra.