This is not a substitute for current CPT and ICD-9 manuals and payer . Refer to the following documents for Blue Shield's payment processing logic and procedure codes: Blue Shield Payment Processing Logic (PDF, 18 KB) Hospital Acquired Condition (HAC)/Never Events Codes (Excel, 346 KB) Effective 10/01/2022 - 09/30/2023. 0000063843 00000 n Remember, Medicare does not accept consultation codes and nothing changes for Medicare in 2023; the consultation codes in the Medicare fee schedule continue to have an Invalid code status. Do not use CPT consultation code ranges 99241-99245, 900-3925-0617 99251-99255 or HCPCS consultation codes G0406-G0408, G0508, G0509 or G0425 . endstream Watch out with BCBS especially because if you code an initial hospital visit when it was actually a consult (as is the common practice with any other payer), they will recoup their payment and you'll have to resubmit a corrected claim. See Medicare Claims Processing Manual: Chapter 12, Page 40 for Observation consult coding advice. 0000001594 00000 n Effective Date October 19, 2019 for claims processed on or after this date. P`LS=$6XSEzH.TD1 A report is required. endobj 0000005607 00000 n endobj Dont make the mistake of always using subsequent care codes, even if the patient is known to the physician. She has been a self-employed consultant since 1998. 0000003366 00000 n Aetna to stop paying for consultation codes | AAFP - brand These codes are used for the inpatient History and Physical (H & P), as well as any specialty consultation (limited to one visit from each specialty). Part B News | Private payers no longer honoring consult codes COVID-19 public health emergency, some . But, the correct category of code is initial hospital care. endobj Check Payer Policies for Consult Code Coverage, Tech & Innovation in Healthcare eNewsletter, Ask 3 Questions to Head Off 2010 Consult Problems. Fasten your seatbelts. 224 0 obj Neglecting to bill consults when the carrier pays them results in lost revenue. <> CPT does not say how the written report is returned: mail, fax, electronic communication. 223 0 obj The following are the most common reasons HCFA/CMS-1500 and UB/CMS-1450 paper claims for Veteran care are rejected: Requires the 17 alpha-numeric internal control number (ICN) [format: 10 digits + "V" + 6 digits] or 9-digit social security number (SSN) with no special characters. In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice.
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