Wiki Initial Hospital care codes for non admitting physicians

[megan5094]

I work for a group of nephrologist that RARELY admit patients. For Medicare patients where you can't bill the consult codes 99251-99255, is it appropriate to crosswalk these codes to the initial Hospital care codes 99221-99223? The description in the book clearly states that these are only for admitting physicians but I am being told it is appropriate to crosswalk these. Please help!

 

[dclark7]

According to CMS directions you are to use the admit codes 99221-99223 instead of consult codes. The admitting physician is supposed to append modifier AI to the admit code and the consulting physician does not use any modifier (unless it's a decision for surgery then append modifier 57). See MLN Matters article http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/mm6740.pdf

Medicare guidelines and CPT guidelines don't always match up when it comes to coding.

 

[Sdenny0420]

Initial Hospital Care

Actually, I have a question. It appears that MC is allowing the use of codes 99221-99223 by the non-admitting physician without the modifier AI, is this correct? This confuses me as in the CPT book it states that these codes are for use by the admitting physician and the non-admitting physician should use the subsequent care codes 99231-99233.
Can someone please clarify this for me?
Thank you.

 

[mitchellde]

The admitting provider must use the AI modifier in order for any consulting physician to be able to bill. Yes it is correct to use the initial inpatient visit levels if this is a requested consult. If you are not consulting, rather your provider is visiting with one of your known patients and following known issues then you submit the subsequent inpatient codes.