AMA Chimes In On How to Report Consults for Non-Medicare Patients

February 4, 2010

Beware: Don’t use the CMS consult crosswalk for billing purposes.

You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article here.

Watch out …The link that was provided for the so-called CMS consult crosswalk is not a crosswalk for billing purposes. CMS used the information to assess how to redistribute the relative values to the new and established E/M outpatient codes (99201-99205, 99212-99215) as well as the initial hospital codes (99221- 99223). This means it has absolutely nothing to do with coding. You need to determine the level of service based on what is documented, not what it might have been had you reported the consult codes (they are no longer in the picture).

The same rule applies for the initial hospital visit. If the physician has not documented a detailed history and exam at a minimum, or documented total time of 30 minutes of which 15 or more minutes was counseling, you cannot report an initial hospital code. Under CMS rules, you would have to bill 99499 (Unlisted evaluation and management service). That means your claim will automatically go into review.

Update: CMS is meeting to discuss the matter and other billing issues that have arisen because of the new policy. Check back with the Coding News or go to www.supercoder.com.

AUDIO: What surgical specialties need to know about consultation reimbursement changes in 2010.

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