Coding Policy Internet Disclaimer I just heard yesterday that CMS may be reconsidering on the Consult codes. As predicted, Medicare Administrative Contractors (MACs) and other payers have implemented this policy change brought forth by the Centers for Medicare & Medicaid Services (CMS). 0000064302 00000 n 258 0 obj We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. CPT does not say how the written report is returned: mail, fax, electronic communication. Where do I go for the definitive answer ? 230 0 obj Payment policies and rules | Blue Shield of CA Provider Clinical & Payment Policies | Buckeye Health Plan Its important to note, however, that this change in coverage applies to public health plan options only. Cigna to Eliminate Consultation Codes - The Rheumatologist While we think of them and even talk about them as admission codes, CPT doesnt use that word. Remember, Medicare does not accept consultation codes and nothing changes for Medicare in 2023; the consultation codes in the Medicare fee schedule continue to have an Invalid code status. [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] CodingIntel was founded by consultant and coding expert Betsy Nicoletti. Part B News | Private payers no longer honoring consult codes <> 0000002225 00000 n According to CPT, these codes are used for new or established patients. Humana Medicare Advantage and commercial plans align with Original Medicare for the reporting of these prolonged services. <> Consultation Codes Update, October 2022: The CPT books have arrived! For all other Medicaid states, however, AmeriChoice currently follows the UnitedHealthcare commercial position and will continue to pay for consult codes until directed otherwise by a state to pursue other strategies. A report is required. 219 0 obj startxref It makes for bigger bureaucracy and more Indian Chiefs! AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules have also implemented CMS rules. Thanks for your help, Copyright 2023, AAPC If the documentation doesnt have a detailed history and detailed exam, then bill a subsequent hospital visit, rather than the initial hospital care services. endobj endstream The requirements for a consultation have not changed. Because the depression screening does not require an interpretation and report, it is not separately paid by this payer. Although I am only just starting out in the coding field, I know one thing well from working in D.C. a few years ago: once the Feds get hold of something, they fix it even if it is not broken! professional who has agreed to accept transfer of care before an initial evaluation. endobj Are consultation codes obsolete? - ACAAI Member CMS is not planning on changing its policy on consultations. Medicare stopped recognizing and paying consult codes, but consults are still requested and provided to inpatients every day. Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding. The payer doesn't accept consultation codes or the service did not meet the criteria for a consultation? 0000004127 00000 n My question to you is are you meeting all three requirements of a consultation? It can affect the timeliness and accuracy of claim payments. Refer to the following documents for Blue Shield's payment processing logic and procedure codes: Blue Shield Payment Processing Logic (PDF, 18 KB) Hospital Acquired Condition (HAC)/Never Events Codes (Excel, 346 KB) Effective 10/01/2022 - 09/30/2023. <> The consultants opinion and any other services that were ordered or performed must also be communicated by written report to the requesting physician, other qualified health care professional, or other appropriate source.. Watch out with BCBS especially because if you code an initial hospital visit when it was actually a consult (as is the common practice with any other payer), they will recoup their payment and you'll have to resubmit a corrected claim. .fl-builder-content *,.fl-builder-content *:before,.fl-builder-content *:after {-webkit-box-sizing: border-box;-moz-box-sizing: border-box;box-sizing: border-box;}.fl-row:before,.fl-row:after,.fl-row-content:before,.fl-row-content:after,.fl-col-group:before,.fl-col-group:after,.fl-col:before,.fl-col:after,.fl-module:before,.fl-module:after,.fl-module-content:before,.fl-module-content:after {display: table;content: " ";}.fl-row:after,.fl-row-content:after,.fl-col-group:after,.fl-col:after,.fl-module:after,.fl-module-content:after {clear: both;}.fl-clear {clear: both;}.fl-clearfix:before,.fl-clearfix:after {display: table;content: " ";}.fl-clearfix:after {clear: both;}.sr-only {position: absolute;width: 1px;height: 1px;padding: 0;overflow: hidden;clip: 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She has been a self-employed consultant since 1998. %PDF-1.7 % When you look in your book, notice that CPT has entirely removed the concept of transfer of care. 0000006009 00000 n Medical coding resources for physicians and their staff. Office consultation codes payment update CORRECTION: In September, this article appeared on Aetna.com with an incorrect start date of December 1, 2021. Rejected Claims-Explanation of Codes - Community Care - Veterans Affairs The code categories remaining to report consultations are code 99241-99245 for office or outpatient consults and 99251-99255 for inpatient consults. 0000005777 00000 n 0000004290 00000 n 0000003954 00000 n <> The reason why Medicare and now most payers don't pay for "consultation" codes is that there were not being used correctly. 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. 0000063843 00000 n This blog is not intended to provide medical, financial, or legal advice. LOL. 223 0 obj I agree with all of the comments made but look at hte bright side. This is not a substitute for current CPT and ICD-9 manuals and payer . Finally. Use either medical decision making or the practitioners total time on the date of the visit to select the level of service. The list of professionals who are other appropriate sources according to CPT includes non-clinical social workers, educators, lawyers or insurance companies. AiE1qi V $`p_p4O- endobj Print Post Jan. 1 has come and gone and so, too, have CPT consultation codes (99241-99255). I am teaching ICBS and my students are asking me what to bill in place of the consult codes. 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. There are four levels of office/outpatient consults and hospital consults. The citation from the Medicare Claims Processing Manual is at the end of this Q&A. The appropriate follow up codes for the hospital setting are CPT codes 99231-99233, and the appropriate . PDF Consultation Services Policy, Professional - UHCprovider.com The use of Coding Policy is not intended to replace independent medical judgement for treatment of individuals. A consultation is provided by a physician or qualified healthcare professional at the request of another physician, qualified healthcare professional, or other professional source. PDF Summary of Consultation Code Coverage by Payer Dont make the mistake of always using subsequent care codes, even if the patient is known to the physician. The advantages to using the consult are codes are twofold: they are not defined as new or established, and may be used for patients the clinician has seen before, if the requirements for a consult are met.. A physician or other qualified health care professional consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.. Im particularly pleased with the fact that we had so much notice when they finally decided to go ahead and do it; issues galore.