From: AccuChecker (Silverio & Associates) tmartinez@accuchecker.com Coding and Billing Tips / Updates for 2000 Email Newsletter May 15, 2000 Free and fast UPIN search for any state and/or specialty. Use the "AccuLibrary" for useful how-to information on billing and coding correctly for nearly all specialties. Hundreds of informative articles. Use e-mail link to request a user name and password- QUICK and EASY signup. Check it out FREE for 2 weeks! Visit our website at - http://accuchecker.com >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Click to view a list of the most useful MEDICAL REIMBURSEMENT BOOKS available in the market! >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> To subscribe or unsubscribe to this service, please see instructions below. The following information was taken from one of the hundreds of reimbursement articles available at: www.accuchecker.com/acculibrary Consultations Procedure Codes and Places of Service 99241 - 99245 Office or Other Outpatient Consultations Valid places of service: 11, 12, 22, 23, 24, 25, 26, 32, 33, 34, 53, 54, 55, 56, 62, 65, 71 and 72 99251 - 99255 Initial Inpatient Consultations Valid places of service: 21, 23, 31, 32, 34, 51, 52, 54 and 61 99261 - 99263 Follow - up Inpatient Consultations Valid places of service: 21, 23, 31, 32, 34, 51, 52, 54 and 61 99271 - 99275 Confirmatory Consultations Valid places of service: 11, 12, 21, 22, 23, 24, 25, 26, 31, 32, 33, 34, 51, 52, 53, 54, 55, 56, 61, 62, 65, 71, 72 and 99 What is a Consultation? A consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or another appropriate source. Consultation Guidelines A physician consultant may initiate diagnostic and/or therapeutic services. The request for a consultation from the attending physician or other appropriate source and the need for consultation must be documented in the patient's medical record. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated to the requesting physician or other appropriate source. There is no limitation of how often a physician may bill for a consultation. Any specifically identifiable procedure performed on or subsequent to the date of the initial consultation should be reported separately. All Consultations must include a written report. IMPORTANT NOTE: WHEN BILLING CONSULTATION SERVICES, ALL CLAIMS MUST HAVE A REFERRING SOURCE, OTHERWISE THE SERVICE WILL BE DENIED OR REDUCED TO A SIMPLE VISIT Medicare claims must contain the referring physician's UPIN number, If subsequent to the completion of a consultation, the consultant assumes responsibility for management of a portion or all of the patient(s) condition, the follow-up consultation codes should not be used. In the hospital setting, the physician receiving the patient for partial or complete transfer of care should use the appropriate inpatient hospital consultation code for the initial encounter and then subsequent hospital care codes (NOT FOLLOW-UP CONSULTATION CODES.) In the office setting, the appropriate established patient office visit code should be used. About "Office or Other Outpatient Consultations": The Office Consultation codes are used for Consultations in the physician's office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, custodial care, or emergency department. Follow-up visits in the consultants' office or other outpatient facility that are initiated by the physician consultant are reported using office visit codes for established patients (99211 - 99215) If an additional request for an opinion or advice regarding the same or a new problem is received from the attending physician and documented in the medical record, the office consultation codes may be used again. About "Follow-Up Inpatient Consultations": Follow-Up consultations are visits to complete the initial consultation OR subsequent consultative visits requested by the attending physician. A Follow-Up Consultation includes monitoring progress, recommending management modifications or advising on a new plan of care in response to changes in the patient's status. If the physician consultant has initiated treatment at the initial consultation, and participates thereafter in the patients' management, the codes for subsequent hospital care should be used (99231 - 99233) About "Confirmatory Consultations": A Consultation initiated by a patient and/or family, and not requested by a physician, is not reported using the initial consultation codes but may be reported using the codes for confirmatory consultation or office visits, as appropriate. If a confirmatory consultation is required e.g., by a third party payor, the Modifier 32 for Mandated Procedures, should also be reported. Confirmatory Consultation codes are also used for such services as second/third opinions requested or required on the necessity or appropriateness of a previously recommended medical treatment or surgical procedure. Confirmatory Consultations may be provided in any setting. ------------------------------------------------------------ ---------------- ---------------------- To subscribe or unsubscribe to this newsletter, please go to www.accuchecker.com, and click on e-mail link to forward your request. ------------------------------------------------------------ ---------------- -------------------------------------------- This document has been forwarded ONLY for the purpose of providing information. The information reflected in this newsletter represents AccuChecker (Silverio & Associates) on the issues posted as of the date of its publication. The user assumes the entire risk of the use and accuracy of the information contained in this document.