CMS at AMA Chicago: We’re Reducing Consult Request Requirement

CMS auditors will look for 1 less thing in consult documentation.

With Medicare’s invalidation of consultation codes 99241-99255 in 2010, your ICD-9 codes better prove why two MDs are necessary on the same patient’s hospital care or the physician better specify why in his note.

Separate ICD-9 codes will help substantiate the medical necessity for providing consultative services, explained 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. If an auditor reviews your hospital code (99221-99233) documentation, different diagnoses will show why more than one physician’s E/M was necessary on the same patient. Next — what auditors WON’T be looking for …

If two physician from different specialties are treating the same problem, there needs to be a clear medically necessary reason of why the additional physician is there, said William J. Mangold, Jr., MD, JD, Noridian Administrative Services’ (Arizona, Montana, Utah, Wyoming) Medicare contractor medical director. The doctor should include the reason he or she needed to see the patient.

You can rest assured that auditors won’t be looking for one thing. “The request for consult documentation will not be there,” Mangold said.

—by Jennifer Godreau

Check out our coding & reimbursement audio updates. Get specialty-specific 2010 training for your entire staff for one low price.

Related articles:

1. Medicare’s Consult Rule Trickle Down Effect And what it means for pediatric practices. A report…
2. Medicare Changes to 2010 CPT Inpatient Consultation Codes Prevent 99251-99245 denials in 2010 with this checklist. Multiple…
3. Medicare 2010 CPT Consultation Code ChangesNew rules for consult coding straight from the AMA Meeting…