Wiki Hospital Consult Medicare

[cwilson3333]

Can someone please refresh me on what code to bill Medicare for an initial hospital consultation, which resulted in surgery. I'm sure I will need to modify the CPT with a
"57", but want to make sure I'm billing the consult correctly.

Thank you,

CW

 

[kvangoor]

Actually Medicare would like you to bill the Intial inpatient day codes 9922X. There is no modifier you need to add. Choose your level based on the documentation. Here is a link from CMS on this.

https://www.cms.gov/MLNMattersArticles/downloads/mm4215.pdf

 

[cwilson3333]

Hospital consults

You made my day easier.

Thank you

Cw

 

[madgejones10]

Per CPT, it has appeared to me (and perhaps I am wrong) that only the admitting physician uses 99221-99223. All other physicians (including consultants) use 99231-99233. If surgery is done, the "57" modifier would be added. Anymore thoughts?

 

[RebeccaWoodward*]

Per CPT, it has appeared to me (and perhaps I am wrong) that only the admitting physician uses 99221-99223. All other physicians (including consultants) use 99231-99233. If surgery is done, the "57" modifier would be added. Anymore thoughts?

Medicare has a different policy. If it's a commerical plan that doesn't follow Medicare, the consultation codes are still applicable. The consultation codes are still valid in CPT.

30.6.10 - Consultation Services (Codes 99241 - 99255)

(Rev. 1875, Issued: 12-14-09, Effective: 01-01-10, Implementation: 01-04-10)

A. Consultation Services versus Other Evaluation and Management (E/M) Visits
Effective January 1, 2010, the consultation codes are no longer recognized for Medicare part B payment. Physicians shall code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed. In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306). The principal physician of record is identified in Medicare as the physician who oversees the patient’s care from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI”, Principal Physician of Record, in addition to the E/M code. Follow-up visits in the facility setting shall be billed as subsequent hospital care visits and subsequent nursing facility care visits. ).

http://www.cms.gov/manuals/downloads/clm104c12.pdf