heatherwinters
Expert
I listened to NGS's second free telephone conference yesterday on coding changes for consultations and I am still confused.
This is my understanding thus far:
If the consult occurs in the ED and you do not admit the patient, you use the ED codes to report your services based on History, Exam and MDM
If the consult occurs in the in-patient setting, you report it using the initial care codes unless you do not have a high enough level if history and exam to bill a 99221 in which case, you would have to revert to a subsequent care code based on the level of documentation you do have.
For observation patients, you would use the 99201 to 99215 codes to report your consult based on whether or not you have seen the patient as an outpatient in the past 3 years. The exception would be those admitted and discharged on the same day, in this case your consultation would be reported using the 99234 to 99236 codes.
The AI modifier is not reserved strictly for the "admitting" MD. It is only to be reported by the MD who expects to be managing the patients care during their entire hospital stay.
The confusion I have is in how they now interpret the initial care codes. I asked the question, If Dr. X sees a patient over the weekend in the hospital and Dr. Y (the patient's primary care MD from a different practice) comes in on Monday and assumes care of the patient, what code should be reported. In this case, the response I got was that Dr. X would bill the initial care codes, and Dr. Y would bill the initial care codes with the AI modifier because he will be the MD responsible for the patient's care during the in-patient stay. This confuses me because in the past, Dr. Y was not providing a "consultation" in this case, he was simply taking over the patient's care and would only have been able to code a subsequent care code. According to the information I received yesterday ALL MD's who see a patient for the first time in-patient can use the initial care codes for their first meeting with the patient during that admission. Now I have consulted another coding specialist regarding this scenerio and he disagrees feeling that,
This is my understanding thus far:
If the consult occurs in the ED and you do not admit the patient, you use the ED codes to report your services based on History, Exam and MDM
If the consult occurs in the in-patient setting, you report it using the initial care codes unless you do not have a high enough level if history and exam to bill a 99221 in which case, you would have to revert to a subsequent care code based on the level of documentation you do have.
For observation patients, you would use the 99201 to 99215 codes to report your consult based on whether or not you have seen the patient as an outpatient in the past 3 years. The exception would be those admitted and discharged on the same day, in this case your consultation would be reported using the 99234 to 99236 codes.
The AI modifier is not reserved strictly for the "admitting" MD. It is only to be reported by the MD who expects to be managing the patients care during their entire hospital stay.
The confusion I have is in how they now interpret the initial care codes. I asked the question, If Dr. X sees a patient over the weekend in the hospital and Dr. Y (the patient's primary care MD from a different practice) comes in on Monday and assumes care of the patient, what code should be reported. In this case, the response I got was that Dr. X would bill the initial care codes, and Dr. Y would bill the initial care codes with the AI modifier because he will be the MD responsible for the patient's care during the in-patient stay. This confuses me because in the past, Dr. Y was not providing a "consultation" in this case, he was simply taking over the patient's care and would only have been able to code a subsequent care code. According to the information I received yesterday ALL MD's who see a patient for the first time in-patient can use the initial care codes for their first meeting with the patient during that admission. Now I have consulted another coding specialist regarding this scenerio and he disagrees feeling that,
Does anyone else have any thoughts on this scenarioreviously, if an MD from a different practice saw a patient in the in-patient setting but did not really provide a "consult" he was simply helping cover for the weekend, he would have only billed a subsequent care code, can that MD now use the 99221-99223 codes to report his first encounter as long as the H, E and MDM requirements are met? Because that is explicitly the understanding I got yesterday. I even pointed out to the presenters that this change would work in some MD's favor as now they would be eligable for higher reimbursement, and they agreed with me. Who else has heard similar information?If a doctor was covering for my doc and did the initial visit I have to treat that patient as we are in the same group. Unless a true transfer from one hospital to the other occured, I'd suggest my doc use a subsequent care code and not another 99221-99223. I'd also suggest that the initial doc covering for me treat that patient as my patient and bill with the AI. I know that is different but I don't feel that portion of the rules has changed. "
Last edited: