Wiki In-hospital consult codes

[Desperate Denise]

I am having difficulty with Blue Shield of Mass. If a patient is seen in the hospital by our orthopedic surgeon at the request of the admiitng physician - am I correct using 99223 and 99222?

If our orthopedic doc is asked to do a consult for a patient who was "admitted" by another physician but only for observation services and not really admitted - is the code 99223 and 99222 with a different place of service?

I thought all along I had been doing this correctly now doubt has been cast by one of the provider reps who was very nice but kinda messed me up.

Any advice will be greatly appreciated - thank you!!!!!

 

[jreich3]

In-hospital consult codes - observation status

Quoting from my handy dandy flyer -

"What about observation patients?

If a patient is in observation status, the physician of record uses the observation codes (99218-99220 or 99234-99236) without a modifier. Other physicians (consultants) who are called to see the patient should use office and outpatient codes, 99201-99215, keeping in mind the definition of a new versus established patient visit." END

Don't forget to change the place of service to outpatient hospital or else the claim will still be rejected.

Also, I don't know about your state, but in NJ BCBC is still accepting the "old" consult codes that pay a little bit higher. Remember the 9924_'s?

Hope that helps.

 

[Bella Cullen]

I am having difficulty with Blue Shield of Mass. If a patient is seen in the hospital by our orthopedic surgeon at the request of the admiitng physician - am I correct using 99223 and 99222?

If our orthopedic doc is asked to do a consult for a patient who was "admitted" by another physician but only for observation services and not really admitted - is the code 99223 and 99222 with a different place of service?

I thought all along I had been doing this correctly now doubt has been cast by one of the provider reps who was very nice but kinda messed me up.

Any advice will be greatly appreciated - thank you!!!!!

99221-99223 are codes that ONLY the doctor who admits the patient as inpatient can use. Those are inpatient admission codes ONLY.

If your doc was asked to do a consult on an inpatient then you would use codes 99251-99255 with the inpatient hospital place of service (21).

If your doc was asked to do a consult on a patient who is there under 24 hrs ("observation status") (who would be considered an outpatient patient), and NOT admitted then you would use codes 99241-99245 for office or other outpatient consults with the outpatient hospital place of service (22). Because I'm assuming doc was asked to consult at the hospital.

Also, the observation codes 99234-99236 and 99218-99220. Those are NOT consult codes. And those codes are for the doc who puts the patient in initial observation care. You cannot use these codes for outpatient observation consult patients. (please read in the CPT book about observation care, read under initial observation care right before 99218 and read under observation or inpatient care services (including admission and discharge services) right before 99234).

And I'm not sure what that person is talking about with NJ BCBS because the 9924_ codes are not "old" codes. Those are the range of codes you would use for office or other outpatient consults. You just can't use consult codes for Medicare anymore. All other insurances still use those.

hope that helps.

 

[mitchellde]

99221-99223 are codes that ONLY the doctor who admits the patient as inpatient can use. Those are inpatient admission codes ONLY.

If your doc was asked to do a consult on an inpatient then you would use codes 99251-99255 with the inpatient hospital place of service (21).

If your doc was asked to do a consult on a patient who is there under 24 hrs ("observation status") (who would be considered an outpatient patient), and NOT admitted then you would use codes 99241-99245 for office or other outpatient consults with the outpatient hospital place of service (22). Because I'm assuming doc was asked to consult at the hospital.

Also, the observation codes 99234-99236 and 99218-99220. Those are NOT consult codes. And those codes are for the doc who puts the patient in initial observation care. You cannot use these codes for outpatient observation consult patients. (please read in the CPT book about observation care, read under initial observation care right before 99218 and read under observation or inpatient care services (including admission and discharge services) right before 99234).

And I'm not sure what that person is talking about with NJ BCBS because the 9924_ codes are not "old" codes. Those are the range of codes you would use for office or other outpatient consults. You just can't use consult codes for Medicare anymore. All other insurances still use those.

hope that helps.

As of Jan 1 2010, when billing Medicare or any other payer that is going by the Medicare policy on consults, you DO use the 99221-99223 codes for inpatient consults as well as admits. Many other insurances have also dropped consult services so you need to check first.

 

[kmdavey]

In Florida- we have the issue with BCBS they will not accept Consult codes - for OBS- we are using
9920_ or 9921_ depending on pt status with our practice and POS is O/P-
Hope this helps with your confusion.

 

[jreich3]

99221-99223 are codes that ONLY the doctor who admits the patient as inpatient can use. Those are inpatient admission codes ONLY.

If your doc was asked to do a consult on an inpatient then you would use codes 99251-99255 with the inpatient hospital place of service (21).

If your doc was asked to do a consult on a patient who is there under 24 hrs ("observation status") (who would be considered an outpatient patient), and NOT admitted then you would use codes 99241-99245 for office or other outpatient consults with the outpatient hospital place of service (22). Because I'm assuming doc was asked to consult at the hospital.

Also, the observation codes 99234-99236 and 99218-99220. Those are NOT consult codes. And those codes are for the doc who puts the patient in initial observation care. You cannot use these codes for outpatient observation consult patients. (please read in the CPT book about observation care, read under initial observation care right before 99218 and read under observation or inpatient care services (including admission and discharge services) right before 99234).

And I'm not sure what that person is talking about with NJ BCBS because the 9924_ codes are not "old" codes. Those are the range of codes you would use for office or other outpatient consults. You just can't use consult codes for Medicare anymore. All other insurances still use those.

hope that helps.

The CPT book is published by the AMA - they have no control over Medicare rules. Medicare (or other insurance companies) doesn't have to "honor" codes just because they are published in the CPT book. You need to keep abreast of changes to Medicare rules on your own. Usually the other companies will follow the rules that Medicare puts into place, but not always. There is no guarentee that the CPT book will drop those codes, so you need to remember NOT to use them.

I had a tough time remembering to USE the old codes on the CCA/CPC tests because the tests were constructed before the new codes went into effect.

I do billing for a doctor here in NJ. BCBSNJ WILL pay for the "old" consult codes, but most insurances won't.

 

[Bella Cullen]

The CPT book is published by the AMA - they have no control over Medicare rules. Medicare (or other insurance companies) doesn't have to "honor" codes just because they are published in the CPT book. You need to keep abreast of changes to Medicare rules on your own. Usually the other companies will follow the rules that Medicare puts into place, but not always. There is no guarentee that the CPT book will drop those codes, so you need to remember NOT to use them.

I had a tough time remembering to USE the old codes on the CCA/CPC tests because the tests were constructed before the new codes went into effect.

I do billing for a doctor here in NJ. BCBSNJ WILL pay for the "old" consult codes, but most insurances won't.

Yea that is what I was saying...Medicare does not use the inpatient and outpatient consult codes anymore. The other insurances still do though.

As of 2010 and 2011 CPT book the consult codes are not deleted and other insurance companies still use those. 99241-99255. Until any or all other insurance companies say NOT to use those codes, I am still billing those for consults with ALL other insurances EXCEPT Medicare because those are still active, billable codes according to the CPT book and according to the other insurance companies guidelines and fee schedules they still accept those consult codes.

So I'm not sure you are understanding what I was saying.

 

[jdemar]

In Pennsylvania, I have found that NO Medicare product (insurance companies) are accepting the consult codes 99251, 99252, 99253, 99254 or 99255 and we are using the admit codes 99221, 99222 or 99223 without the admit modifier....if you are the admitting physician (attending physician) then you need the modifier -AI = (admit inpatient) hope this helps you.