Medical Billing Forum
Coding => Coding => : blessed May 10, 2011, 02:32:50 PM
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I've been away from the Billing & Collection work for over three years, just started working for a specialist, trying to clean his A/R, I found a lot of unpaid 99254 some done at a hospital setting, and others at the office, my question: is this code still valid, has it not been deleted ?
I am aware that the claims needs to have a Ref. Phys. on it for this claim to be paid, and every one of them does, yet, some got paid and a lot didn't !!
Any idea why ?
blessed
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Reading the code in the 2011 book, it's an INPATIENT code, so I don't think in the office will work. Also it indicates 80 minutes spent with the patient, you may need notes to back it up.
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Thanks a lot.
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Medicare no longer allows for "Consultation" codes. Most commercial carriers do still use them. So it is likely that that is what happened to your MD.
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Medicare discontinued use of consult codes effective w/dates of service 1-1-10 and after. For office/outpatient consults (99241-99245) you use the comparable codes for E&M services 99201 - 99215 using the 3-year rule for new vs. established patients; for inpatient consults (99251-99255) you use the initial inpatient codes 99221-99223. As other posters mentioned, some commercial payers still use the consult codes so you have to verify whether or not that particular payer accepts them.