Yes, I agree; making the rules clearer and getting rid of some of those acronyns would be a good start for sure. Other carriers are following suit. Because the depression screening does not require an interpretation and report, it is not separately paid by this payer. They are used to help identify whether health care services are correctly coded for reimbursement. endobj Can we share or not share? Starting March 1, 2022, we will no longer pay office consultation codes 99241, 99242, 99243, 99244 and 99245. I wonder if our doctors will ever get back to being able to practice medicine and not insurance OR law? endobj hb```b`` @QRy`2I&iLKHbD`
juqh Consultation services are described with CPT codes 99242-99245 (office and outpatient) and 99252-99255 (inpatient and observation). After CMS eliminated the codes Jan. 1, private payers could choose to continue reimbursing the codes or follow CMS's lead. <>/Metadata 24 0 R/Pages 23 0 R/StructTreeRoot 26 0 R/Type/Catalog/ViewerPreferences 221 0 R>> MDwise N/A N/A Not covered for dates of service (DOS) on or after February 1, 2015 Follows Medicare Policy Not Covered MHS N/A N/A Not covered for dates of service (DOS) on or after February 1, 2015 Follows Medicare Policy Not Covered Medicare Effective January 1, 2010, does not covers consultation codes Follows Medicare Policy Not Covered N/A . Sacrifice: A payer that still accepts the consultation codes probably has not adjusted its fee schedule, like Medicare has, to allow higher payment for other E/M codes. The requirements for a consultation have not changed. 0000064141 00000 n
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Most groups suggest that their clinicians continue to select and document consults (when the service is a consult) whether or not they know if the payer recognizes consults or not. 0000003617 00000 n
221 0 obj endobj The list of professionals who are other appropriate sources according to CPT includes non-clinical social workers, educators, lawyers or insurance companies. When you look in your book, notice that CPT has entirely removed the concept of transfer of care. The correct start date is March 1, 2022. Bill primary payer consult codes: Your second choice is to bill the primary payer using the consult codes. endobj startxref Effective Date October 19, 2019 for claims processed on or after this date. AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules have also implemented CMS rules. Humana Medicare Advantage and commercial plans align with Original Medicare for the reporting of these prolonged services. If you pass the claim on to the MSP using the consult code, the . She knows what questions need answers and developed this resource to answer those questions. 0000028304 00000 n
%%EOF Generally, BCBSMS follows CPT, HCPCS and ICD-10-CM national coding guidelines. endobj The reason why Medicare and now most payers don't pay for "consultation" codes is that there were not being used correctly. CPT instructions do state that the consultation codes 99241-99245 may be used for consultations services in the ER, so that would be correct for payers that still accept those codes. <> Effective for claims with dates of service on or after Oct. 1, 2019, UnitedHealthcare aligns with CMS and does not reimburse consultation service codes 99242-99245, 99252-99255, including when reported with telehealth modifiers for any practice or care provider, regardless of the fee schedule or payment methodology applied. 220 0 obj 233 0 obj Category of code for payers that dont recognize consult codes, Definition of a consultationupdated with 2023 CPT guidance, There is a request from another healthcare professional or other appropriate source. [278 0 0 556 0 0 667 191 333 333 0 0 278 333 278 278 556 556 556 556 556 556 556 556 556 556 278 0 0 0 0 556 0 667 667 722 722 667 611 778 722 278 500 0 0 833 722 778 667 778 722 667 611 722 667 944 0 0 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 0 500 222 833 556 556 556 556 333 500 278 556 500 722 0 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 737] Here's our dilemma: We have a number of commercial payers who say they follow Medicare rules on split/shared visits, but they still recognize consult codes 99241-99245 (for office consults) and 9925199255 (initial inpatient consults). 0000014227 00000 n
CPT is a registered trademark of the American Medical Association. Modifier -32 CPT modifier -32 is intended to identify cases in which a consultation was mandated by entities such as a third-party payer, government agency, or regulatory requirement. On June 1, 2019, UHC discontinued payment for practices whose contracted rates are based on a stated year 2010 or later Medicare fee schedule. Im particularly pleased with the fact that we had so much notice when they finally decided to go ahead and do it; issues galore. Oh wellI guess all these changes are good for our brains! <>stream
235 0 obj what is the best way to check how this change affects the HMO plans? Therefore, Humana plans only allow HCPCS codes G2212, G0316, G0317 and G0318; and Humana plans do not allow 99417 or 99418. <>/MediaBox[0 0 612 792]/Parent 23 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> If the documentation doesnt support the lowest level initial hospital care code, use a subsequent hospital care code (9923199233). 0000002225 00000 n
0000006009 00000 n
Outpatient consultations (9924199245) and inpatient consultations (9925199255) were still active CPT codes, and depending on where you are in the country, are recognized by a payer two, or many payers. This is challenging to answer as there is not an agreed upon interpretation of the rule. 0000001594 00000 n
Outpatient consultations (9924199245) and inpatient consultations (9925199255) were still active CPT codes, and depending on where you are in the country, are recognized by a payer two, or many payers. I am teaching ICBS and my students are asking me what to bill in place of the consult codes. There are four levels of office/outpatient consults and hospital consults. I dont have an answer to give them because I am getting a lot of conflicting info. 229 0 obj 0000013094 00000 n
Do not use CPT consultation code ranges 99241-99245, 900-3925-0617 99251-99255 or HCPCS consultation codes G0406-G0408, G0508, G0509 or G0425 . Many commercial insurance companies still recognize consults. And, with it, there is a consultation codes update for 2023. <> Chances are your dealing with Dr. A wants the patient to be evaluated by Dr. B, and Dr. B wants to bill a consultation which is incorrect. For office and outpatient services, use new and established patient visit codes (9920299215), depending on whether the patient is new or established to the physician, following the CPT rule for new and established patient visits. 0000003954 00000 n
I am looking for information that the insurance companies have put on there web sites. endobj The statement that I recommend is I am seeing this patient at the request of Dr. Patel for my evaluation of new onset a-fib. At the end of the note, indicate that a copy of the report is being returned to the requesting clinician. xref
0000063843 00000 n
For an inpatient service, use the initial hospital services codes (9922199223). ~]@Zu"@E0Ld\pQ,P,Nca|!a2E6YYVpg0A2cFa.dNdc(8L.@Y ,1 234 0 obj The correct inpatient consultation codes for a first evaluation are 99221-99223. endobj endobj If the documentation doesnt have a detailed history and detailed exam, then bill a subsequent hospital visit, rather than the initial hospital care services. Medical coding resources for physicians and their staff. AiE1qi
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$`p_p4O- These two low level consult codes were rarely used. More government bureaucracy yet to come! Don't forget since consults still use the 95/97 guidelines, you may frequently get a higher level with 99202-99215 if your clinician misses an exam bullet point or doesn't completely document a history. If only we had more hours in a day to keep up with the publications. UnitedHealthcare announced earlier this year that they would eliminate the consultation codes in two phases. In the past, the codes 99221-99223 were used only for the admitting physicians, and the codes 99251-99255 were . They set up an edit in their system so that consult codes can be reviewed and cross walked to the appropriate code, depending on the payer. endstream All rights reserved. Invalid Service Facility Address. In a shared medical record, this can be done electronically. According to the author, Joel I. Shalowitz, MD, MBA, Consultation codes are being billed erroneously at a high rate. 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