Medicare Eliminates Consult Codes - What Now?

Aetna Health Insurance - Medicare Eliminates Consult Codes - What Now?

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One of the most considerable changes for Medicare billing recently is the elimination of payment for consultation codes. Your institution will have to adjust how you bill for these types of services or you will find a lot of denials.

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Just in case you have not had a opening to read the newly released fee agenda (just kidding, it is a lot to read), I have summarized the section on consulting codes below.

Here are the facts concerning this new ruling and the potential impact on your practice.

1. Consultation codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated. Tele-health consultation G-codes (G0425-G0427) will not be eliminated.

2. Use codes for new (99201-99205) or established (99211-99215) patients to replace consultations in the office/outpatient setting.

3. Codes in the inpatient hospital setting (99221-99223) should be used to replace inpatient consultation codes (99251-99255), and for nursing installation consultations use codes (99304-99306).

4. To distinguish the unlikeness in the middle of the admitting physician of report from the consultants for initial hospital inpatient and nursing installation admissions, Medicare will manufacture a modifier. Check with your local carrier for more information.

5. Payments for all estimation and administration codes have been increased in an exertion to offset the fees lost from the elimination of consultation codes.

An foremost note concerning industrial or private insurance. No facts has been released by other third party payers concerning payment for consultation codes as of yet. However, if your inpatient has Medicare as a secondary payer, a decision will need to be made by the physician as to how you will report the consultation. Any consultation claim filed with a industrial insurer such as Blue Cross or Aetna who is primary using the eliminated consultation codes when Medicare is secondary would corollary in a denial for the secondary claim by Medicare. In those instances where Medicare is secondary, you may want to reconsider using the new guidelines as stated above for reporting consultation codes.

One more note. If you have not updated your enrollment facts with Medicare since November 2003, you must do so. Although enrolled in Medicare, many physicians who are eligible to refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment report is one that is in the Medicare supplier enrollment, chain and ownership law (Pecos) and also contains the physician's national supplier identifier (Npi).

Follow these few easy guidelines and you should have no qoute being paid for consulting codes.

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