How to Navigate CPT’s 99241-99255 Section in 2010
Posted on January 19, 2012 | No Comments
Erin Masercola asked:
No doubt about it. One of the biggest coding challenges in 2010 will be how to code consults – or what used to be consults. Hospital inpatient visits will be especially tricky.
But don’t worry. My Coding Career has consulted the experts to gather these 10 best practices for consult coding in 2010.
The background: Medicare has scrapped consultation codes, and in 2010 will no longer accept codes from CPT’s 99241-99255 section. So, when you’re billing Medicare, you’ll have to find other codes to describe what used to be consults. Meanwhile, some non-Medicare payers will continue to accept consultation codes.
Here are 10 steps you can take to get paid and stay compliant:
1. Expect some larger payers to ditch consult codes as well. Some larger private payers (such as Blue Cross Blue Shield, Aetna, and Humana) will follow Medicare’s lead and won’t accept consult codes in 2010, experts predict.
2. Check with your payers. Some payers will continue to accept consult codes. Payers will announce their consult code policies by mid-December.
Tip for executing #1 & #2: Keep a spreadsheet to track each of your payers’ 2010 consult code policies, and be sure to document their instructions.
Next, what about Medicaid?
3. If you bill Medicaid, check with your state for consult instructions. Just because Medicare isn’t accepting consult codes doesn’t mean things are the same for Medicaid across the board.
4. If two or more physicians see a patient during a hospital stay, make double-sure the ICD-9 codes and/or the physician notes justify the need for two or more physicians to see the patient.
5. Stop thinking of CPT 99221-99223 as ‘admit codes.’ When a physician consults a patient on his first day in the hospital, you should use an initial hospital code. More than one physician can use an initial hospital care code for the same patient, as long as you keep #4 in mind.
6. Meet modifier ‘AN.’ When billing Medicare, modifier ‘AN’ designates a doctor as the admitting physician. If no one uses the modifier, the claim will be subject to medical review, experts predict.
7. Look at time when choosing codes for hospital inpatient care you’re billing to Medicare. At the higher levels, consults’ transfer to hospital care codes will benefit your practice’s bottom line. For 99244 and 99245, you would gain approximately 30 percent in pay if you also report the prolonged services.
8. Expect reimbursement to be lower for lower-level hospital inpatient visits that would have been consults under Medicare’s old system.
9. Focus on total work when coding for split/shared inpatient visits for Medicare. You can ignore one requirement here thanks to Medicare’s invalidation of the consult codes. Even if the physician does not duplicate the key components that the nonphysician practitioner (NPP) performed, you can count all medically necessary history, examination, and medical decision making that the and physician each individual performs and documents on a calendar day.
10. Apply your new/established patient rules when coding visits that would have been consults under Medicare’s old rules. For example, say an internist sends a patient to a cardiologist for an opinion, and that patient saw that cardiologist two years before. The cardiology practice should choose from the ‘established’ patient codes to bill the visit.
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No doubt about it. One of the biggest coding challenges in 2010 will be how to code consults – or what used to be consults. Hospital inpatient visits will be especially tricky.
But don’t worry. My Coding Career has consulted the experts to gather these 10 best practices for consult coding in 2010.
The background: Medicare has scrapped consultation codes, and in 2010 will no longer accept codes from CPT’s 99241-99255 section. So, when you’re billing Medicare, you’ll have to find other codes to describe what used to be consults. Meanwhile, some non-Medicare payers will continue to accept consultation codes.
Here are 10 steps you can take to get paid and stay compliant:
1. Expect some larger payers to ditch consult codes as well. Some larger private payers (such as Blue Cross Blue Shield, Aetna, and Humana) will follow Medicare’s lead and won’t accept consult codes in 2010, experts predict.
2. Check with your payers. Some payers will continue to accept consult codes. Payers will announce their consult code policies by mid-December.
Tip for executing #1 & #2: Keep a spreadsheet to track each of your payers’ 2010 consult code policies, and be sure to document their instructions.
Next, what about Medicaid?
3. If you bill Medicaid, check with your state for consult instructions. Just because Medicare isn’t accepting consult codes doesn’t mean things are the same for Medicaid across the board.
4. If two or more physicians see a patient during a hospital stay, make double-sure the ICD-9 codes and/or the physician notes justify the need for two or more physicians to see the patient.
5. Stop thinking of CPT 99221-99223 as ‘admit codes.’ When a physician consults a patient on his first day in the hospital, you should use an initial hospital code. More than one physician can use an initial hospital care code for the same patient, as long as you keep #4 in mind.
6. Meet modifier ‘AN.’ When billing Medicare, modifier ‘AN’ designates a doctor as the admitting physician. If no one uses the modifier, the claim will be subject to medical review, experts predict.
7. Look at time when choosing codes for hospital inpatient care you’re billing to Medicare. At the higher levels, consults’ transfer to hospital care codes will benefit your practice’s bottom line. For 99244 and 99245, you would gain approximately 30 percent in pay if you also report the prolonged services.
8. Expect reimbursement to be lower for lower-level hospital inpatient visits that would have been consults under Medicare’s old system.
9. Focus on total work when coding for split/shared inpatient visits for Medicare. You can ignore one requirement here thanks to Medicare’s invalidation of the consult codes. Even if the physician does not duplicate the key components that the nonphysician practitioner (NPP) performed, you can count all medically necessary history, examination, and medical decision making that the and physician each individual performs and documents on a calendar day.
10. Apply your new/established patient rules when coding visits that would have been consults under Medicare’s old rules. For example, say an internist sends a patient to a cardiologist for an opinion, and that patient saw that cardiologist two years before. The cardiology practice should choose from the ‘established’ patient codes to bill the visit.
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