Thursday, July 8, 2010

How to billing hospital consultation service

New Medicare Coding for Consultation Services


Crosswalks for Emergency Department Consultations requiring admission of patient into inpatient facility
CPT Consultative Services Code CPT E/M Codes for Crosswalking Modifier Required
99251 99221 (Inpatient Initial Visit, level 1) Yes, you will need to append Modifier “AI”
99252 99221 (Inpatient Initial Visit, level 1) or
99222 (Inpatient Initial Visit, level 2)		 Yes, you will need to append Modifier “AI”
99253 99222 (Inpatient Initial Visit, level 1) Yes, you will need to append Modifier “AI”
99254 99222 (Inpatient Initial Visit, level 2) or
99222 (Inpatient Initial Visit, level 3)		 Yes, you will need to append Modifier “AI”
99255 99223 (Inpatient Initial Visit, level 3) Yes, you will need to append Modifier “AI”






Crosswalks for Inpatient Consultations
CPT Consultative Services Code CPT E/M Codes for Crosswalking Modifier Required
99251 99221 (Inpatient Initial Visit, level 1) Yes, referring physician (not you)
will need to append Modifier “AI”
99252 99221 (Inpatient Initial Visit, level 1) or
99222 (Inpatient Initial Visit, level 2)		 Yes, referring physician (not you)
will need to append Modifier “AI”
99253 99222 (Inpatient Initial Visit, level 1) Yes, referring physician (not you)
will need to append Modifier “AI”
99254 99222 (Inpatient Initial Visit, level 2) or
99222 (Inpatient Initial Visit, level 3)		 Yes, referring physician (not you)
will need to append Modifier “AI”
99255 99223 (Inpatient Initial Visit, level 3) Yes, referring physician (not you)
will need to append Modifier “AI”
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download