Coding Strategy

Beware: Don’t use the CMS consult crosswalk for billing purposes.

You may be seeing light at the end of the tunnel. The AMA just published an article to clarify the use of the consultation codes for non-Medicare patients, and talks about their efforts to get CMS to delay their new policy. You can find the article here.

Watch out …The link that was provided for the so-called CMS consult crosswalk is not a crosswalk for billing purposes. CMS used the information to assess how to redistribute the relative values to the new and established E/M outpatient codes (99201-99205, 99212-99215) as well as the initial hospital codes (99221- 99223). This means it has absolutely nothing to do with coding. You need to determine the level of service based on what is documented, not what it might have been had you reported the consult codes (they are no longer in the picture).

The same rule applies for the initial hospital visit. If the physician has not documented a detailed history and exam at a minimum, or documented total time of 30 minutes of which 15 or more minutes was counseling, you cannot report an initial hospital code. Under CMS rules, you would have to bill 99499 (Unlisted evaluation and management service). That means your claim will automatically go into review.

Update: CMS is meeting to discuss the matter and other billing issues that have arisen because of the new policy. Check back with the Coding News or go to www.supercoder.com.

AUDIO: What surgical specialties need to know about consultation reimbursement changes in 2010.

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We’ve got the link to a nifty ICD-9 to ICD-10 code translator.

Maybe I’m getting old, but I just can’t believe we’re about to ring in the second decade of the 21st century. It seems like just yesterday I was toasting the new millennium and breathing a sigh of relief that “Y2K” wasn’t the big catastrophe we all dreaded.

With time whizzing by so fast, now’s the time to prepare for ICD-10 implementation. And some coders dread ICD-10 as much as anyone ever dreaded Y2K. The number of our diagnosis codes will swell from 13,500 to 120,000, for example. And if we’re certified coders, we’ll have to demonstrate our ICD-10 expertise in order to maintain our certifications. I know I’m too old for another test!

If you feel like you’re already behind on ICD-10, here are 3 links to help you learn more.

For some free webinars that teach you ICD-10 basics and help you plan for implementation, go here. The AAPC’s Deborah Grider gives you some quick tutorials and some helpful slides.

Tip: If you’re a coder who works for a payer, the AAPC has a handy free webinar track designed especially for you.

I really like this handy ICD-9 to ICD-10 code translator tool available on the AAPC web site. The folks at AAPC have developed the tool from CMS files, and I’ve enjoyed playing around on it to get an idea of how my diagnosis coding will change with ICD-10.

Finally, the complete set of ICD-10 codes is available here from CMS. I’ve not read it cover to cover. Perhaps I’ll save it for beach reading this summer.

Want easy, quick ways to learn more about ICD-10? Stay tuned to Coding News. Will teach you as we learn ourselves.

Here’s one more reason to celebrate 2010: Your FREE trial to Supercoder. Get details here.

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