Author Topic: Consultation code 99254  (Read 2246 times)

blessed

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Consultation code 99254
« on: May 10, 2011, 11:32:50 AM »
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
 

DMK

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Re: Consultation code 99254
« Reply #1 on: May 10, 2011, 11:46:16 AM »
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.

blessed

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Re: Consultation code 99254
« Reply #2 on: May 10, 2011, 02:43:45 PM »
Thanks a lot.

drp

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Re: Consultation code 99254
« Reply #3 on: May 10, 2011, 11:04:48 PM »
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. 

pattil88

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Re: Consultation code 99254
« Reply #4 on: May 11, 2011, 07:11:47 AM »
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.