decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 2 (February)
Some carriers want unlisted code in place of low-level consults
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Article Overview
This article explains payer responses to Medicare’s changes affecting consultation services and outlines how different Medicare contractors and private insurers were handling related evaluation and management claims. It is aimed at coding professionals, billers, and practice administrators who need to understand where payer policies diverge, what broad claim categories are being used, and which organizations had issued guidance. The discussion centers on inpatient hospital settings, contractor-level policy variation, and the status of consult payment across Medicare and private plans.
Why This Topic Matters
Because consultation coding policies were not uniform across payers, practices needed to know which organizations still recognized consult services, which required alternative evaluation and management coding approaches, and which asked for supporting documentation. Understanding these differences helps reduce denials and aligns billing with payer-specific policy.
Article Sections
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Inpatient visits and Medicare contractor policy
This section discusses Medicare’s approach to consultation service changes in the inpatient setting and summarizes how different contractors were handling related claim types. It highlights the variation in payer guidance without providing selection instructions.
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Private payer policies
This section reviews how selected commercial and managed care payers were responding to the consultation payment changes. It also notes that state medical societies and specialty organizations were tracking payer-specific policies.
What You Will Learn
- How Medicare contractor policies differed after consultation payment changes
- What broad types of evaluation and management claim categories were being referenced for inpatient services
- How private payer policies varied across commercial and managed care plans
- Which organizations were publicly tracking consultation policy changes
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician office administrators
- Compliance teams
Codes Discussed
Code Ranges Discussed
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