Wiki ID Consult Question need help asap

[MikeVee]

I have an ID consult as a client, and I have never billed for an ID consult before.

Based on my research consultation codes are no longer payable by medicare and other insurances. How would I bill an initial consultation visit? I read that if I use codes 99221-99223 they can be denied if the master physician used the same codes for his initial consult without the AI modifier. I also read that medicare wants you to use the subsequent care codes when billing consults 99212-99215, but they pay half as much.
Does anyone have experience billing ID consults and can give me their input? Thanks

 

[mhstrauss]

I have an ID consult as a client, and I have never billed for an ID consult before.

Based on my research consultation codes are no longer payable by medicare and other insurances. How would I bill an initial consultation visit? I read that if I use codes 99221-99223 they can be denied if the master physician used the same codes for his initial consult without the AI modifier. I also read that medicare wants you to use the subsequent care codes when billing consults 99212-99215, but they pay half as much.
Does anyone have experience billing ID consults and can give me their input? Thanks

There are still many payers allowing consult codes...based on the examples you gave, I'm assuming you are referring to inpatient services. In general:

For Medicare (including the advantage plans), and any payers that no longer pay consult codes: You will use the initial inpatient codes 99221-99223 for the consult charge. You should not have any problem with this. The admitting physician uses the same codes, but with the AI modifier--this is how payers will differentiate the consultant from the admitting.

For any commercial payers (in my area--Baton Rouge, LA--this includes BCBS, United Healthcare, Humana, Aetna, Coventry, etc) that are still paying consults, you will use the inpatient consult codes 99251-99255.

The subsequent codes you listed 99212-99215 are outpatient, not inpatient, so these should not apply.


HTH!