Coding Tips to get paid and stay compliant

Medicare has done away with consultation codes and in 2010 will no longer accept codes from CPT’s 99241-99255 section. As such, we are bound to encounter a lot of challenges pertaining to consult codes in the coming year. Hospital inpatient visits will especially be tricky. If you are planning to craft a career in medical billing and coding, you need to stay on top of these challenges.

Here we bring you 10 best practices for consult coding in 2010.

• You can expect some larger payers to ditch consult codes as well.

• You should check with your payers. Some payers will still accept consult codes.

Here’s what you can do: Keep a spreadsheet to track each of your payers’ 2010 consult code policies and document their instructions for sure.

• Check with your state for consult instructions if you bill Medicaid. Just because Medicare is not accepting consult codes does not mean that things are the same for Medicaid across the board.

• During a hospital stay, if two or more physicians tend to a patient, ensure the ICD-9 codes and /or the physician notes justify the need for two or more physicians to see the patient.

• You should not consider CPT 99221-99223 as ‘admit codes now.

• While billing Medicare, modifier ‘AN’ designates a doctor as the admitting physician. Experts predict that if no one uses the modifier, the claim will be subject to medical review.

• When choosing codes for hospital inpatient care you’re billing to Medicare, you need to look at time.

• You should anticipate reimbursement to be lower for lower-level hospital in patient visits that would have been consults under Medicare’s old system.

• You should focus on total work while coding for split/shared inpatient visits for Medicare.

• You should apply your new/established patient rules while coding visits that would have been consults under Medicare’s previous rules.