Medicare Changes to 2010 CPT Inpatient Consultation Codes

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Prevent 99251-99245 denials in 2010 with this checklist.

Multiple physicians using the same hospital codes sounds like a recipe for denials, but that’s what Medicare is instructing physician inpatient consultants and care coordinators to do.

Whether carriers will kick out these submissions as coordination of care or inpatient admit limiting admit edits is contractor specific, Charles E. Haley, MD, MS, FACP, Medicare medical director for Trailblazer Health Enterprises, LLC, told the audience during the E/M session at the 2010 CPT symposium. “If come January you’re getting denials, work out the issues with your specific contractor.”

You can, however, prevent many rejections from Medicare’s invalidation of 99251-99245 by following this checklist.

√ Use Initial Hospital Day Codes on Day 1

If a physician consults a patient on his first day in the hospital, you should use an initial hospital code (99221-99223), according to Medicare’s new consultation guidelines for 2010. “Stop thinking of these codes as admit codes,” cautioned Peter A. Hollmann, MD, the AMA CPT Editorial Panel, Vice Chair. They are for initial hospital care. “We should say ‘admitting physician’ when we mean just that.

More than one physician can use an initial hospital care code for the same patient. If two physicians from different specialties are both consulting on a patient, both physicians use the initial code. Next, what’s up with modifier AN?

√ Designate Admitter With Modifier

Surgery coders will have to educate primary care physicians who perform the majority of admissions on attaching an appendage to indicate his role as the admitting doctor. “The physician of record will use the initial code with a modifier,” stressed Kenneth B. Simon, MD, MBA, CMS senior medical officer, in “Medicare Physician Payment Schedule 2010 Changes and Beyond” at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago. All other same day submitted claims for initial hospital care codes will presumably be consultants.

What if the main physician doesn’t use the proposed modifier AN? If no one uses the modifier, the claim will be subject to medical review, Simon predicts. “Other claims will be held ‘pending review,’” Simon said.

Will using different diagnoses let claims avoid being held up for lack of an admitting physician modifier designation? No, separate diagnoses won’t make a difference in the initial claim processing phase, Simon said. They will, however, help support medical necessity.

by Jennifer Godreau

2010 E/M Coding Update, an audio training event your entire office can attend for one low price. Presented by Duane Abbey, PhD, CFP.

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