Wiki Inpatient Visit Billing for Professional Provider

[thoffert]

I code for professional orthopedic physicians and we treat patient's in the local hospital everyday because we are the trauma physicians on call. I was curious to find out how others were billing inpatient consults for a professional physician. It is our understanding that that we can not bill Inpatient Consultation E&M codes (99251-55) for Medicare Patients; therefore we bill Initial Inpatient Care E&M codes (99221-23) or Subsequent Hospital Care (99231-33) for Medicare patients.

However,how is everyone billing these items for Commercial insurances. Do you use 99251-55 (Inpatient Consultation Codes) for commercial insurances? Does your practice get paid for these services? Have you changed your billing to using all 99221-33 codes for all insurances?

Insight into how other professional providers are billing these items would be much appreciated. Thank you for your assistance.

 

[thomas7331]

The last two practices I worked for as a coder billed the consultation codes to the commercial plans that accepted them and we received payment. Some commercial plans do follow Medicare, so the only real challenge can be to know which ones do or don't. There can be issues with having to recode or submit corrected claims in cases where a patient's insurance has changed and the practice was not aware, or where the patient has a secondary payer that does not accept the consultation codes, so there can be a bit of re-work involve in doing it this way. More and more payers seem to be following Medicare's lead on this, but they do typically publish something in advance before making the change in their claims system so that you can prepare for it and avoid having claims denied, but at some point, depending on your payer mix, it may not be worth the extra effort to bill differently to different payers.