I'm hearing from other coders that when they've contacted their "main" carriers for their states, some carriers had no idea what they were talking about. They actually had to fax the carrier a copy of the reg. The more and more I think about it...some things are starting to make sense. Excerpt from reg...
"The determination of the appropriate visit code should be made solely on the basis of the existing rules and guidelines for the use of the relevant visit codes (for example, office visit or inpatient visit), without any reference to the guidelines that have been employed for the use of the consultation codes. The guidelines for use of the visit codes are well established and well understood. Therefore, we do not believe that it is necessary to provide any coding crosswalk or guidelines for translating the consultation code requirements into the appropriate visit codes."
Based on that statement, it's critical to know chapter 12 of the Medicare manual....inside and out...
Now...I would like some opinions on this scenario...
If my physician performed a “so called inpatient consultation” POS 21, he will bill 99221-99223 (assuming he met the minimal requirements for 99221). Now when this patient is transferred to IRC (POS 61), he would not bill another 99221-99223 but rather a subsequent visit?
Physician Services Involving Transfer From One Hospital to Another; Transfer Within Facility to Prospective Payment System (PPS) Exempt Unit of Hospital; Transfer From One Facility to Another Separate Entity Under Same Ownership and/or Part of Same Complex; or Transfer From One Department to Another Within Single Facility
Physicians may bill both the hospital discharge management code and an initial hospital care code when the discharge and admission do not occur on the same day if the transfer is between:
Different hospitals; (NO)
Different facilities under common ownership which do not have merged records; or (records are merged)
Between the acute care hospital and a PPS exempt unit within the same hospital when there are no merged records. (NO)
In all other transfer circumstances, the physician should bill only the appropriate level of subsequent hospital care for the date of transfer.
I'm saying subsequent visit for the transfer to IRC...any disputes?