Wiki Medicare Crosswalk Consult Codes

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CrysLednum

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Hi - We are having a discussion on the crosswalk codes that Medicare Part B News provided, dated December 9,2009.

If we used to bill 99243 we are now being instructed to bill either 99203 or 99213.

But in a followup case I don't think 99213 is adequate to 99243. Assuming the same documentation is available for a correct code of 99243, I think that a 99214 would be more comparable.

Does this sound correct?
 
You are correct, 99243 would not crosswalk to 99213, it crosswalks to 99214 unless it is based on time and in that case would crosswalk to 99215.

Anytime you see a crosswalk it is best to double check it based on CPT definition of the codes. When you are taking codes that are 3 of 3 down to codes that are 2 of 3 you have to be careful. And as I mentioned check your times. They are different for each code set. On the inpatient side the times for 99221-99223 are 30 min 50 min and 70 min a 99254 is 80 min. So if you are coding based on time 99254 goes to 99223 but if you are coding based on key components it goes to 99222.

Hope this is helpful,

Laura, CPC, CEMC
 
I am not sure why there is a need for a crosswalk of any kind. The transmittal CMS put out has instructed that the guidelines for the required levels be followed so if the documentation is equivalent to a level 4 then it is a 5 then it is. You must follow the stated parameters for either a new patient or established patient or initial inpatient. Forget about what level it would be as a consult and look at what level it is for the type of patient it is just as though it were not a consult.
 
Crosswalk

Part B New is written by Decision Health not by Medicare. Per Medicare there is no Crosswalk. I agree with this but I am being told by my manager and supervisor to just use these codes. I am not sure if the Doctors are aware that we are doing this. Isn't this illegal? Are my CPC credentials on the line if I do this without the documentation in front of me or the Dr's permission? Would something in writing from my manager cover me in this situation?

Very worried and don't look good in orange.:confused:
 
You must have the documenttion to code a visit level there is no crosswalk these are very different levels of service and the only way to assign one is by using the 95/97 guidelines with the documentation. If this is not provided then you have a choice to submit the consult code selected and know it will be denied or submit no E&M at all.
 
Split/Shared and Consults

There are differing opinions on whether or not you can do split/shared with consults now since you crosswalk them to an E/M and ultimately that is what you are billing to Medicare. But on the other hand intent of the visit was a consult which Medicare rules state cannot be split/shared. Does anyone have any credible guidance on this?
 
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