Wiki Consults

[kbarron]

I am just back to coding after 1 2/2 yr absence. I am looking for clarification on consults. New surgeon at our facility states she has been using consult codes at her former employer. When CMS changed the consult codes to non covered, our CAH Method II opted NOT to use these any more, even though a handful of insurances pay for them. Doctor states we are leaving $$ on the table..I explained that there are too many ins that do not cover them. She needs to use the proper E&M code. She is saying I am wrong. I do know that AI is for Principal Physician of Record. We have hospitalist who admit and follow the pts, so AI would be on the admitting MD and approp hospital codes for surgeon who was consulted. Thanks for any help in advance.

 

[mdoyle53]

I agree with the MD that the practice would be leaving money on the table. The way to do this is in the practice management/billing system. I would have the doctors code the consult and then there should be a table in the software that will allow you to indicate for a particular code as to what to code. This could be difficult in some instances but why leave $ on the table when it is not necessary.

 

[kbarron]

Some of the insurances we contract do pay for them..but in the case that MCR is 2ndry, then no payment would made. Would this be pt responsibility where MCR does not cover this and is ABN necessary?