Health Information Management

Healthcare News: CMS transmittal provides guidance on consultation coding changes

JustCoding News: Inpatient, January 6, 2010

Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Inpatient!

On December 14, 2009, CMS issued Transmittal 1875 in the Medicare Claims Processing Manual regarding consultation codes, which Medicare will no longer accept effective January 1.

The guidance in this Transmittal is for physicians and nonphysician practitioners (NPP) who perform initial evaluation and management (E/M) consultations for Medicare beneficiaries and submit claims to Medicare carriers, Fiscal Intermediaries, and/or Medicare Administrative Contractors for those services. It is also intended for Method II critical access hospitals, which bill for the services of those physicians and NPPs who have reassigned their billing rights.

As of January 1, Medicare will no longer recognize consultation codes (CPT codes 99241–99245 and codes 99251–99255).

Providers should instead report the appropriate E/M code that identifies where the visit occurred as well as the complexity of the services administered during the visit.

In inpatient and nursing facility settings, providers who perform initial evaluations may bill an initial hospital care visit code (99221–99223) or nursing facility care visit code (codes 99304–99306), when appropriate. Physicians should report the code that most appropriately describes the level of the services he or she provided.

The admitting physician should append new modifier -AI (Principal physician of record) to the E/M code. This modifier will identify the physician who oversees the patient’s care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient should bill only the E/M code for the complexity level performed.

For patients receiving hospital outpatient observation services who are not subsequently admitted to the hospital as inpatients, physicians should report CPT codes 99217–99220. In the event another physician evaluation is necessary, the physician who provides the additional evaluation bills the office or other outpatient visit codes when they provide services to the patient.

For more information, access MedLearn Matters article MM6740.

Interested in learning more about consultation code changes for Medicare claims? Joan Lowes, JD, and Joe Rivet, CCS-P, CPC, CEMC, CICA, discussed CMS’ new no-pay policy for consultation codes during a December 21 HCPro audio conference, “Medicare Consultation Code Changes in 2010: Ensure Accurate Coding and Billing for Appropriate Payment.” To learn more or to purchase, go to the Healthcare Marketplace Web site.



Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Inpatient!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • Auditing Evaluation and Management Services

    Auditing Evaluation and Management Services is an essential tool to ensure audit success and E/M compliance. This second...

Most Popular