Wiki Medicare Consults

[Cothran]

On my surgical consults, my doctor is only documenting a brief history. Since the Medicare consults are the hospital admission codes and require a detailed or comprehensive history, is this billable?

 

[LLovett]

Depends on who the carrier is

Most carriers allow you to drop down to the subsequent care codes in that scenario.

For awhile WPS Medicare instructed us to use the unlisted E/M 99499 and send documentation. They backed off that advice pretty quickly and allowed the sub care codes to be utilized when the elements are not present to support the lowest level admit.

Laura, CPC, CPMA, CPC-I, CANPC, CEMC