Absent Consult Codes: Let These 4 Tips Guide Your E/M Choice

Why This Topic Matters

The topic matters because payer-specific rules can affect whether a claim is submitted as a consultation or as another evaluation and management service, especially in hospital and office settings where multiple physicians may be involved. It also highlights the need to align coding processes with CMS guidance and payer policy changes.

Article Sections

1. Inventory Your Payers

   Discusses how payer policy differences can affect billing choices and reimbursement workflows. It emphasizes the importance of checking whether a payer follows the same approach as Medicare.

2. Turn to Office Codes for Outpatient

   Covers office and outpatient evaluation and management categories used when consultation billing is not applicable. It also addresses the general concept of patient status in that setting.

3. Adjust to Initial Hospital Care

   Reviews hospital inpatient evaluation and management categories and the broader issue of selecting among them based on documentation. It also references concerns about crosswalks and CMS guidance.

4. Solve the 2 Physician Problem with AI

   Explains the general issue of multiple physicians billing initial hospital care and the related CMS modifier used to identify the physician overseeing care. It also notes the continuation of initial-versus-subsequent distinctions.